Evaluating C-Reactive Protein in Drainage Fluid as a Predictive Biomarker for Clinically Relevant Pancreatic Fistulas Following Pancreaticoduodenectomy

BACKGROUND: This study was conducted to determine the use of C-reactive protein (CRP) levels in drainage fluid as an alternative indicator of clinically relevant postoperative pancreatic fistulas (CR-POPFs) following pancreaticoduodenectomy (PD). Reportedly, serum CRP levels are associated with CR-POPFs. Drainage fluid following PD is used to diagnose a pancreatic fistula, removing the need for blood sampling. However, the significance of CRP in drainage fluid remains unclear. METHODS: In this retrospective study, we reviewed consecutive patients who underwent PD at Hiroshima University between April 2014 and October 2021. Clinical factors for CR-POPFs were analyzed, and serum and drain CRP levels were measured during the first 4 days after surgery. RESULTS: Among the 384 patients enrolled, 58 (15.1%) developed CR-POPFs. Serum and drain CRP levels on postoperative days (PODs) 2, 3, and 4 were significantly associated with CR-POPFs. Receiver operating characteristic analysis indicated that CRP levels on POD 4 most precisely predicted CR-POPFs, with area under the curve values of 0.820 and 0.803 for serum and drain CRP levels, respectively. Additionally, these two factors exhibited a strong positive correlation (p