Postoperative procalcitonin is a biomarker for excluding the onset of clinically relevant pancreatic fistula after pancreaticoduodenectomy

Background: Early detection and therapy of pancreatic fistula after pancreaticoduodenectomy is crucial to improve outcomes of this surgery. Since it is not clear if procalcitonin (PCT), can predict the onset of clinically relevant pancreatic fistula (CR-POPF), we aimed to investigate this ability.Methods: One-hundred-thirty pancreaticoduodenectomies (PD) were analyzed. Receiver Operating Characteristic curves analysis defined the optimal cut-of fs for PCT and drains amylase levels (DAL). Complications were compared using chi-square for proportions test.Results: DAL >_2,000 U/L in postoperative day (POD) 2 had 71% PPV and 91% NPV for CR-POPF (P<0.001). In POD2, PCT >_0.5 ng/mL showed NPV 91% (P<0.045) and increased DAL PPV for CR-POPF to 81%. In POD3, POD4 and POD5, DAL (cut-offs 780 U/L, 157 U/L and 330 U/L, respectively) showed NPV for CR-POPF >90% (P<0.0001). PCT >_0.5 ng/mL showed NPV for CR-POPF of about 90%. In POD5, combining DAL (cut-off 330 U/L) and PCT (cut-off 0.5 ng/mL), a PPV for CR-POPF of 81% was detected. A progressive increased risk of CR-POPF from POD2 (OR =3.05; P=0.0348) to POD5 (OR =4.589; P=0.0082) was observed. In POD2 and 5, PCT >_0.5 ng/mL, alone and in combination with DAL, may be a reliable marker for identifying patients at highest risk of CR-POPF after PD.Conclusions: This association could be proposed to select high risk patients that could benefit of "intensive" postoperative management.