Limited utility of inflammatory markers in the early detection of postoperative inflammatory complications after pancreatic resection: Cohort study and meta-analyses

• Inflammatory complications after pancreatic surgery are difficult to predict and manage.
• C-reactive protein has the best diagnostic accuracy (74%) in predicting these complications.
• However, CRP on its own it has limited clinical utility.
• Meta-analyses confirmed low accuracy.

PurposeTo examine the diagnostic accuracy of systemic inflammatory markers in early prediction of inflammatory postoperative complications (IPC) and clinically-relevant pancreatic fistula (PF).MethodsPreoperative and postoperative [until postoperative day (POD) 4)] measurements of hemoglobin, white blood cell counts (WBC), neutrophil/lymphocyte ratio (NLR) and C-reactive protein (CRP) were correlated with IPC and PF. Meta-analyses of biochemical predictors were performed.ResultsNinety-two out of 378 patients developed IPC, PF occurred in 31. Preoperative WBC (OR 1.0001, 95% CI: 1.0001–1.0002, p = 0.02), NLR on POD2 (OR 1.05, 95% CI: 1.006–1.1, p = 0.02) and CRP on POD4 (OR 1.006, 95% CI: 1.002–1.01, p = 0.02) predicted IPC at multivariate analysis. The model including these three variables showed a diagnostic accuracy of 76.8% (sensitivity 20, specificity 97%.14; PPV 71.43, PPN 77.27) and, at logistic regression analysis an OR of 8.5 (95% CI: 2.5–28.6, p < 0.001). Only CRP >272 on POD3 (OR 3.32, 95% CI: 1.46–7.52, p = 0.003) was associated with PF with a diagnostic accuracy of 74% (sensitivity 54.5, specificity 78.5; PPV 16.88, NPV 94.25). Meta-analyses of available data suggested sensitivity of 75.3% (95% CI 66.7–82.6) and specificity of 75.5% (95% CI 61.3–85.7). However, these studies were significantly heterogeneous.ConclusionsReadily available, routine tests have limited utility in predicting IPC. Further research is required to develop novel biomarkers to aid management of these patients.