RESUMEN
BACKGROUND: Prediction of complications after pancreatoduodenectomy (PD) remains of interest. Blood parameters and biomarkers during first and second postoperative days (POD1, POD2) may be early indicators of complications. METHODS: This case-control study included 50 patients. Baseline, POD1 and POD2 values of leukocytes, neutrophils, lymphocytes, platelets, hemoglobin, C-reactive protein (CRP), procalcitonin and arterial lactate were compared between individuals presenting Clavien ≥ III morbidity, pancreatic fistula (PF) or clinically relevant PF (CRPF) and those without these morbidities. Common variables reaching significance were further analyzed in order to calculate a predictive score. RESULTS: Severe morbidity, PF and CRPF rates were 28.0%, 26.0% and 14.0%, respectively. Patients with severe morbidity had lower leukocytes on POD2 (Pâ¯=â¯0.04). Patients with PF presented higher CRP on POD2 (Pâ¯=â¯0.001), higher lactate on POD1 (Pâ¯=â¯0.007) and POD2 (Pâ¯=â¯0.008), and lower lymphocytes on POD1 (Pâ¯=â¯0.007) and POD2 (Pâ¯=â¯0.008). Patients with CRPF had lower leukocytes and neutrophils on POD1 (Pâ¯=â¯0.048, Pâ¯=â¯0.038), lower lymphocytes on POD1 (Pâ¯=â¯0.001) and POD2 (Pâ¯=â¯0.003), and higher CRP on POD2 (Pâ¯=â¯0.001). Baseline parameters and procalcitonin obtained no statistical associations. Score was defined according to lymphocytes on POD1 < 650/µL and CRP on POD2 ≥ 250â¯mg/L allocating patients in 3 risk categories. PF and CRPF rates were statistically higher as risk category increased (P<0.001). Receiver operating characteristic curves and Hosmer-Lemeshow tests showed a good accuracy. CONCLUSIONS: Impaired immunological reaction during early postoperative period (lower leukocytes and, particularly, lymphocytes) in response to surgical aggression would favor complications after PD. Likewise, acidosis (higher arterial lactate) could behave as risk factor of PF. An elevated CRP on POD2 is also an early biomarker of PF. Our novel score based on postoperative lymphocyte count and CRP seems reliable for early prediction of PF.
Asunto(s)
Proteína C-Reactiva/análisis , Lactatos/sangre , Fístula Pancreática/etiología , Pancreaticoduodenectomía/efectos adversos , Anciano , Estudios de Casos y Controles , Femenino , Humanos , Masculino , Persona de Mediana Edad , Morbilidad , Fístula Pancreática/inmunologíaRESUMEN
Human pancreatic fluid obtained from 2 subjects, each with a traumatic pancreatic fistula, contained detectable levels of IgG, IgA, IgM, IdD, and IgE. Although the mean IgG/IgA ratio for 10 random specimens was 1.63, the relative concentration was estimated to be less than unity when extreme values were eliminated. The molecular weight of IgA in pancreatic fluid was found to be comparable to that of the IgA molecule in serum. The absence of secretory component in pancreatic IgA provides further evidence that pancreatic IgA and serum IgA are similar. Serial determinations of the immunoglobulins stored at 4 degrees C showed a progressive decrease of all immunoglobulins, the order of stability being IgG approximately equal to IgA larger than IgM approximately equal to IgD. The demonstrated proteolytic activity in the specimens could account for the immunoglobulin decay and for the variable detection of IgM and IgD in pancreatic-fluid specimens.