Ioannis Mintziras, Sabine Wächter, Jerena Manoharan, Veit Kanngiesser, Elisabeth Maurer, Detlef K Bartsch
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Patients with POH had higher rates of clinically relevant postoperative pancreatic fistula (cr-POPF) (44.3 vs. 3.7%, <i>p</i> < 0.001) and clinically relevant postoperative complications than those without POH (39.3 vs. 21.1%, <i>p</i> = 0.001). Patients with cr-POH had higher C-reactive protein (CRP, milligrams per liter) levels on third (257.7 vs. 187.85 mg/L, <i>p</i> = 0.016) and fourth (222.5 vs. 151, <i>p</i> = 0.002) postoperative day (POD) than those with POH alone. Serum procalcitonin (PCT, micrograms per liter) levels on POD 2 (1.2 vs. 0.4 μg/L, <i>p</i> = 0.028) and POD 3 (0.85 vs. 0.4 μg/L, <i>p</i> = 0.001) were also higher in patients with cr-POH. Rates of cr-POPF in patients with cr-POH were higher than in those with POH alone (70.8 vs. 27%, <i>p</i> = 0.001). POH (OR 0.011, 95% CI: 0.001-0.097, <i>p</i> < 0.001) was an independent predictor of cr-POPF in the multivariable analysis. A high-risk pathology, defined as nonadenocarcinoma/nonchronic pancreatitis pathology (OR 0.277, 95% CI: 0.106-0.727, <i>p</i> = 0.009), and a small duct diameter (OR 0.333, 95% CI: 0.139-0.796, <i>p</i> = 0.013) were independent predictors of POH in the multivariable analysis.</p><p><strong>Conclusion: </strong>POH is a frequent, but not always clinically relevant, finding after partial PD. Serum CRP and PCT levels in the early postoperative period can be used to identify patients with cr-POH. POH is an independent risk factor for increased postoperative morbidity, including cr-POPF, after partial PD.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":"38 6","pages":"384-392"},"PeriodicalIF":1.8000,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801325/pdf/","citationCount":"1","resultStr":"{\"title\":\"Clinical Implications of Postoperative Hyperamylasemia after Partial Pancreaticoduodenectomy.\",\"authors\":\"Ioannis Mintziras, Sabine Wächter, Jerena Manoharan, Veit Kanngiesser, Elisabeth Maurer, Detlef K Bartsch\",\"doi\":\"10.1159/000526495\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The present study aimed to examine the clinical implications of postoperative hyperamylasemia (POH) after partial pancreaticoduodenectomy (PD).</p><p><strong>Methods: </strong>Data from all consecutive patients undergoing PD were obtained from a prospectively maintained database and reviewed. POH was defined as an elevation of serum pancreatic amylase above the upper limit of normal (53 U/L) on postoperative days 0-2. Clinically relevant POH (cr-POH) was defined as POH in patients with clinically relevant (Clavien-Dindo ≥ III) postoperative complications.</p><p><strong>Results: </strong>POH occurred in 61 of 170 (35.9%) and cr-POH in 24 of 170 (14.1%) patients. Patients with POH had higher rates of clinically relevant postoperative pancreatic fistula (cr-POPF) (44.3 vs. 3.7%, <i>p</i> < 0.001) and clinically relevant postoperative complications than those without POH (39.3 vs. 21.1%, <i>p</i> = 0.001). Patients with cr-POH had higher C-reactive protein (CRP, milligrams per liter) levels on third (257.7 vs. 187.85 mg/L, <i>p</i> = 0.016) and fourth (222.5 vs. 151, <i>p</i> = 0.002) postoperative day (POD) than those with POH alone. Serum procalcitonin (PCT, micrograms per liter) levels on POD 2 (1.2 vs. 0.4 μg/L, <i>p</i> = 0.028) and POD 3 (0.85 vs. 0.4 μg/L, <i>p</i> = 0.001) were also higher in patients with cr-POH. Rates of cr-POPF in patients with cr-POH were higher than in those with POH alone (70.8 vs. 27%, <i>p</i> = 0.001). POH (OR 0.011, 95% CI: 0.001-0.097, <i>p</i> < 0.001) was an independent predictor of cr-POPF in the multivariable analysis. A high-risk pathology, defined as nonadenocarcinoma/nonchronic pancreatitis pathology (OR 0.277, 95% CI: 0.106-0.727, <i>p</i> = 0.009), and a small duct diameter (OR 0.333, 95% CI: 0.139-0.796, <i>p</i> = 0.013) were independent predictors of POH in the multivariable analysis.</p><p><strong>Conclusion: </strong>POH is a frequent, but not always clinically relevant, finding after partial PD. Serum CRP and PCT levels in the early postoperative period can be used to identify patients with cr-POH. POH is an independent risk factor for increased postoperative morbidity, including cr-POPF, after partial PD.</p>\",\"PeriodicalId\":56003,\"journal\":{\"name\":\"Visceral Medicine\",\"volume\":\"38 6\",\"pages\":\"384-392\"},\"PeriodicalIF\":1.8000,\"publicationDate\":\"2022-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9801325/pdf/\",\"citationCount\":\"1\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Visceral Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000526495\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2022/10/24 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Visceral Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000526495","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2022/10/24 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 1
摘要
本研究旨在探讨部分胰十二指肠切除术(PD)后高淀粉酶血症(POH)的临床意义。方法:从前瞻性维护的数据库中获得所有连续PD患者的数据并进行回顾。POH定义为术后0-2天血清胰淀粉酶高于正常上限(53 U/L)。临床相关POH (cr-POH)定义为有临床相关(Clavien-Dindo≥III)术后并发症的患者的POH。结果:170例患者中POH 61例(35.9%)，cr-POH 24例(14.1%)。POH患者术后临床相关胰瘘(cr-POPF)发生率(44.3比3.7%，p < 0.001)和术后临床相关并发症发生率(39.3比21.1%，p = 0.001)均高于无POH患者。术后第3天(257.7 vs. 187.85 mg/L, p = 0.016)和第4天(222.5 vs. 151, p = 0.002)， cr-POH患者的c反应蛋白(CRP，毫克/升)水平高于单纯POH患者。cr-POH患者血清降钙素原(PCT，微克/升)POD 2 (1.2 vs. 0.4 μg/L, p = 0.028)和POD 3 (0.85 vs. 0.4 μg/L, p = 0.001)水平也较高。cr-POH患者的cr-POPF发生率高于单纯POH患者(70.8 vs 27%， p = 0.001)。在多变量分析中，POH (OR 0.011, 95% CI: 0.001-0.097, p < 0.001)是cr-POPF的独立预测因子。在多变量分析中，高风险病理，定义为非腺癌/非慢性胰腺炎病理(OR 0.277, 95% CI: 0.106-0.727, p = 0.009)和小导管直径(OR 0.333, 95% CI: 0.139-0.796, p = 0.013)是POH的独立预测因子。结论:POH是部分PD后常见的，但并不总是与临床相关。术后早期血清CRP和PCT水平可用于鉴别cr-POH患者。POH是部分PD后术后发病率增加的独立危险因素，包括cr-POPF。
Clinical Implications of Postoperative Hyperamylasemia after Partial Pancreaticoduodenectomy.
Introduction: The present study aimed to examine the clinical implications of postoperative hyperamylasemia (POH) after partial pancreaticoduodenectomy (PD).
Methods: Data from all consecutive patients undergoing PD were obtained from a prospectively maintained database and reviewed. POH was defined as an elevation of serum pancreatic amylase above the upper limit of normal (53 U/L) on postoperative days 0-2. Clinically relevant POH (cr-POH) was defined as POH in patients with clinically relevant (Clavien-Dindo ≥ III) postoperative complications.
Results: POH occurred in 61 of 170 (35.9%) and cr-POH in 24 of 170 (14.1%) patients. Patients with POH had higher rates of clinically relevant postoperative pancreatic fistula (cr-POPF) (44.3 vs. 3.7%, p < 0.001) and clinically relevant postoperative complications than those without POH (39.3 vs. 21.1%, p = 0.001). Patients with cr-POH had higher C-reactive protein (CRP, milligrams per liter) levels on third (257.7 vs. 187.85 mg/L, p = 0.016) and fourth (222.5 vs. 151, p = 0.002) postoperative day (POD) than those with POH alone. Serum procalcitonin (PCT, micrograms per liter) levels on POD 2 (1.2 vs. 0.4 μg/L, p = 0.028) and POD 3 (0.85 vs. 0.4 μg/L, p = 0.001) were also higher in patients with cr-POH. Rates of cr-POPF in patients with cr-POH were higher than in those with POH alone (70.8 vs. 27%, p = 0.001). POH (OR 0.011, 95% CI: 0.001-0.097, p < 0.001) was an independent predictor of cr-POPF in the multivariable analysis. A high-risk pathology, defined as nonadenocarcinoma/nonchronic pancreatitis pathology (OR 0.277, 95% CI: 0.106-0.727, p = 0.009), and a small duct diameter (OR 0.333, 95% CI: 0.139-0.796, p = 0.013) were independent predictors of POH in the multivariable analysis.
Conclusion: POH is a frequent, but not always clinically relevant, finding after partial PD. Serum CRP and PCT levels in the early postoperative period can be used to identify patients with cr-POH. POH is an independent risk factor for increased postoperative morbidity, including cr-POPF, after partial PD.
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