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.
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
