C-Reactive Protein in Predicting Post Pancreatectomy Hemorrhage and Postoperative Pancreatic Fistula After Pancreaticoduodenectomy: A Prospective Cohort Study

Abstract

Introduction:Despite advances in surgical techniques, technology and perioperative care, mortality and morbidity following PD is as high as 5% and 35-60% respectively. POPF, PPH are the leading cause of morbidity and mortality following PD and the prediction of these complications is one of the important aims of post operative care. We aim to determine the role of C-reactive protein in the prediction of POPF and PPH.

Methods: Data from  patients who underwent pancreaticoduodenectomy from December 2021 to February 2023 was collected. Postoperative day 1 and day 3 CRP assay was done and occurrence of PPH and POPF was recorded. Linear regression analysis and ROC curve were used to derive the results.

Results: Among the 46 patients analyzed, 12(26.08%) patients developed PPH and 8(17.39%) developed POPF which included 3(6.52%) CR-POPF and the mortality rate was 4.34%. Mean day 1 and day 3 CRP was 27.464 and 22.938 in patients of PPH with standard coefficients of 0.661 and 0.647 (p=0.001). Mean CRP was 11.718 and 2.153 in POPF on day 1 and day 3, but it was not statistically significant (p=0.152, p= 0.769 respectively). At cut off values of  CRP>17.5 mg/dl, the sensitivity and specificity of day 3 CRP in predicting grade C PPH was 86% and 77% (p=0.001).

Conclusions: High CRP levels can predict the development of PPH and thereby reduce the morbidity and mortality by early identification of at-risk patients.