Journal of Gastrointestinal Surgery

, Volume 22, Issue 5, pp 818–830 | Cite as

C-Reactive Protein on Postoperative Day 1 Is a Reliable Predictor of Pancreas-Specific Complications After Pancreaticoduodenectomy

  • Théophile Guilbaud
  • David Jérémie Birnbaum
  • Coralie Lemoine
  • Mircea Chirica
  • Olivier Risse
  • Stéphane Berdah
  • Edouard Girard
  • Vincent Moutardier
Original Article



Postoperative pancreatic fistula and pancreas-specific complications have a significant influence on patient management and outcomes after pancreatoduodenectomy. The aim of the study was to assess the value of serum C-reactive protein on the postoperative day 1 as early predictor of pancreatic fistula and pancreas-specific complications.


Between 2013 and 2016, 110 patients underwent pancreaticoduodenectomy. Clinical, biological, intraoperative, and pathological characteristics were prospectively recorded. Pancreatic fistula was graded according to the International Study Group on Pancreatic Fistula classification. A composite endpoint was defined as pancreas-specific complications including pancreatic fistula, intra-abdominal abscess, postoperative hemorrhage, and bile leak. The diagnostic accuracy of serum C-reactive protein on postoperative day 1 in predicting adverse postoperative outcomes was assessed by ROC curve analysis.


Six patients (5%) died and 87 (79%) experienced postoperative complications (pancreatic-specific complications: n = 58 (53%); pancreatic fistula: n = 48 (44%)). A soft pancreatic gland texture, a main pancreatic duct diameter < 3 mm and serum C-reactive protein ≥ 100 mg/L on postoperative day 1 were independent predictors of pancreas-specific complications (p < 0.01) and pancreatic fistula (p < 0.01). ROC analysis showed that serum C-reactive protein ≥ 100 mg/L on postoperative day 1 was a significant predictor of pancreatic fistula (AUC: 0.70; 95%CI: 0.60–0.79, p < 0.01) and pancreas-specific complications (AUC: 0.72; 95%CI: 0.62–0.82, p < 0.01). ROC analysis showed that serum C-reactive protein ≥ 50 mg/L at discharge was a significant predictor of 90-day hospital readmission (AUC: 0.70; 95%CI: 0.60–0.79, p < 0.01).


C-reactive protein levels reliably predict risks of pancreatic fistula, pancreas-specific complications, and hospital readmission, and should be inserted in risk-stratified management algorithms after pancreaticoduodenectomy.


Pancreaticoduodenectomy C-reactive protein Pancreas-specific complications Postoperative pancreatic fistula 90-day readmission 


Author Contribution

All authors did the following:

- Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data;

- Drafting the work or revising it critically for important intellectual content;

- Final approval of the version to be published;

- Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflicts of interest.


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Copyright information

© The Society for Surgery of the Alimentary Tract 2017

Authors and Affiliations

  • Théophile Guilbaud
    • 1
  • David Jérémie Birnbaum
    • 1
  • Coralie Lemoine
    • 2
  • Mircea Chirica
    • 3
  • Olivier Risse
    • 3
  • Stéphane Berdah
    • 1
  • Edouard Girard
    • 3
  • Vincent Moutardier
    • 1
  1. 1.Department of Digestive Surgery, Hôpital NordAix-Marseille UniversityMarseilleFrance
  2. 2.Self perceived Health Assessment Research Unit and Department of Public healthAix-Marseille UniversityMarseilleFrance
  3. 3.Department of Digestive Surgery and Liver Transplantation, Hôpital MichalonGrenoble UniversityGrenobleFrance

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