A Predictive Risk Scoring System for Clinically Relevant Pancreatic Fistula After Pancreaticoduodenectomy

Wuzheng Xia, Yu Zhou, Ye Lin, Min Yu, Zi Yin, Xin Lu, Baohua Hou, Zhixiang Jian, Wuzheng Xia, Yu Zhou, Ye Lin, Min Yu, Zi Yin, Xin Lu, Baohua Hou, Zhixiang Jian

Abstract

BACKGROUND Postoperative pancreatic fistula remains a challenge after pancreaticoduodenectomy (PD). This study aimed to establish a scoring system to predict clinically relevant postoperative pancreatic fistula (CR-POPF) after PD. MATERIAL AND METHODS The clinical records of 361 consecutive patients who underwent PD between 2009 and 2017 were reviewed retrospectively. Patients were divided into a study group (225 patients) and a validation group (136 patients). CR-POPF was defined and classified based on the 2016 ISGPS definition and classification system. Univariate and multivariate logistic regression analyses were performed and we thus developed a scoring system based on the regression coefficient of the multivariate logistic regression model. The predictive value was determined using the receiver operating characteristic (ROC) curve. RESULTS A predictive scoring system with a maximum of 6 points for CR-POPF was established using the following 4 factors: 1 point for soft pancreatic texture (OR 2.09, 95%CI 1.10-3.98, P=0.025), 1.5 points for main pancreatic duct diameter ≤2.5 mm (OR 2.72, 95%CI 1.23-5.99, P=0.013), 0.5 points for extended lymphadenectomy (OR 1.57, 95%CI 1.13-2.18, P=0.007), 0.5 points for a 25-30 g/L postoperative day 1 serum albumin (OR 1.43, 95%CI 1.02-2.00, P=0.037), and 3 points for postoperative day 1 serum albumin ≤25 g/L (OR 5.12, 95%CI 1.82-14.41, P=0.002). The ROC curve showed that this scoring system was highly predictive for CR-POPF in the validation group (AUC=0.806, 95%CI: 0.735-0.878). CONCLUSIONS This 6-point risk scoring system will be useful for perioperative risk management of CR-POPF.

Conflict of interest statement

Conflicts of interest

None.

Figures

Figure 1
Figure 1
Two receiver operating characteristic (ROC) curves for the estimated probability of CR-POPF calculated based on the scoring system. The area under the curve for the study group (AUC1) was 0.813 (95%CI: 0.737–0.889) and the area under the curve for the validating group (AUC2) was 0.806 (95%CI: 0.735–0.878).

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