Novel risk scoring system for prediction of pancreatic fistula after pancreaticoduodenectomy  

作　　者：Ye Li Fang Zhou Dong-Ming Zhu Zi-Xiang Zhang Jian Yang Jun Yao Yi-Jun Wei Ya-Ling Xu Dei-Chun Li Jian Zhou 

机构地区：[1]Department of General Surgery,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China [2]Pancreatic Disease Research Centre,The First Affiliated Hospital of Soochow University,Suzhou 215006,Jiangsu Province,China

出　　处：《World Journal of Gastroenterology》2019年第21期2650-2664,共15页世界胃肠病学杂志（英文版）

基　　金：Supported by the Key Research and Development of Jiangsu Province of China,No.BE2016673;the Jiangsu Province"333"Project,No.BRA2018392;the Jiangsu Provincial Medical Youth Talent,No.QNRC2016734;Six Talent Peaks Project in Jiangsu Province,No.WSW-059;the Project of Suzhou People’s Livelihood Science and Technology,No.SS201632

摘　　要：BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula (CR-POPF) do not incorporate both preoperative and intraoperative variables. AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors. METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy (PD) or pylorus-preserving PD (PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study (01/2011 to 12/2014) or validation (01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak (grade A) and CR-POPF (grades B and C). Logistic regression was used to create a predictive scoring system. RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio (OR)= 0.92, 95% confidence interval (CI): 0.85-0.99], hard pancreatic texture (P = 0.004, OR = 0.25, 95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm (P = 0.029, OR = 0.50, 95%CI: 0.27-0.93), and intraoperative blood loss ≥ 500 mL (P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was 0.821 (95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model. CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high- and low-risk populations in order to facilitate timely interventions after PD.BACKGROUND The available prediction models for clinically relevant postoperative pancreatic fistula(CR-POPF) do not incorporate both preoperative and intraoperative variables.AIM To construct a new risk scoring system for CR-POPF that includes both preoperative and intraoperative factors.METHODS This was a retrospective study of patients who underwent pancreaticoduodenectomy(PD) or pylorus-preserving PD(PPPD) between January 2011 and December 2016 at the First Affiliated Hospital of Soochow University. Patients were divided into a study(01/2011 to 12/2014) or validation(01/2015 to 12/2016) group according to the time of admission. POPF severity was classified into three grades: Biochemical leak(grade A) and CR-POPF(grades B and C). Logistic regression was used to create a predictive scoring system.RESULTS Preoperative serum albumin ≥ 35 g/L [P = 0.032, odds ratio(OR) = 0.92, 95%confidence interval(CI): 0.85-0.99], hard pancreatic texture(P = 0.004, OR = 0.25,95%CI: 0.10-0.64), pancreatic duct diameter ≥ 3 mm(P = 0.029, OR = 0.50, 95%CI:0.27-0.93), and intraoperative blood loss ≥ 500 mL(P = 0.006, OR = 1.002, 95%CI:1.001-1.003) were independently associated with CR-POPF. We established a 10-point risk scoring system to predict CR-POPF. The area under the curve was0.821(95%CI: 0.736-0.905) and the cut-off value was 3.5. Including drain amylase levels improved the predictive power of the model.CONCLUSION This study established a 10-point scoring system to predict CR-POPF after PD/PPPD using preoperative and intraoperative parameters. Ultimately, this system could be used to distinguish between high-and low-risk populations in order to facilitate timely interventions after PD.

关 键 词：POSTOPERATIVE PANCREATIC FISTULA PANCREATICODUODENECTOMY Risk factor Predictive model Complications SCORING SYSTEM 

分 类 号：R[医药卫生]