Early Post-Operative Pancreatitis and Systemic Inflammatory Response Assessed by Serum Lipase and IL-6 Predict Pancreatic Fistula

S Gasteiger, F Primavesi, G Göbel, E Braunwarth, B Cardini, M Maglione, S Sopper, D Öfner, S Stättner, S Gasteiger, F Primavesi, G Göbel, E Braunwarth, B Cardini, M Maglione, S Sopper, D Öfner, S Stättner

Abstract

Background: Post-operative pancreatic fistula (POPF) remains a critical complication after pancreatic resection. This prospective pilot study evaluates perioperative markers of pancreatitis and systemic inflammation to predict clinically relevant grade B/C-POPF (CR-POPF).

Methods: All patients undergoing pancreatic resection from December 2017 to April 2019 were prospectively enrolled. Surgical procedures and outcomes were correlated with perioperative blood markers. ROC analysis was performed to assess their predictive value for CR-POPF. Cut-offs were calculated with the Youden index.

Results: In total, 70 patients were analysed (43 pancreatoduodenectomies and 27 distal pancreatectomies). In-hospital/90-d mortality and morbidity were 5.7/7.1% (n = 4/n = 5) and 75.7% (n = 53). Major complications (Clavien-Dindo ≥ 3a) occurred in 28 (40.0%) patients, CR-POPF in 20 (28.6%) patients. Serum lipase (cut-off > 51U/L) and IL-6 (> 56.5 ng/l) on POD3 were significant predictors for CR-POPF (AUC = 0.799, 95%-CI 0.686-0.912 and AUC = 0.784, 95%-CI 0.668-0.900; combined AUC = 0.858, 95%-CI 0.758-0.958; all p < 0.001). Patients with both or one factor(s) above cut-off more frequently developed CR-POPF than cases without (100 vs. 50% vs. 7.5%, p < 0.001). This also applied for overall and severe complications (p = 0.013 and p = 0.009).

Conclusions: Post-operative pancreatitis and inflammatory response are major determinants for development of POPF. A combination of serum lipase and IL-6 on POD3 is a highly significant early predictor of CR-POPF and overall complications, potentially guiding patient management.

Clinical trial registration: The study protocol was registered at clinicaltrials.gov (NCT04294797).

Conflict of interest statement

All authors declare no conflict of interest for this article.

Figures

Figure 1
Figure 1
ROC analysis of the predictive value of lipase and IL-6 on POD3 (a) and both factors combined (b) for development of clinically relevant post-operative pancreatic fistula (CR-POPF)
Figure 2
Figure 2
Post-operative overall and severe morbidity (a) and clinically relevant post-operative pancreatic fistula (CR-POPF) as well as mortality (b) stratified by the presence of none, one or both serum markers (lipase and IL-6) above the calculated cut-off
Figure 3
Figure 3
Time courses of serum lipase and IL6 according to patients stratified by further development of clinically relevant post-operative pancreatic fistula (CR-POPF). XY-line graphs are shown with median and interquartile range error bars

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