Nitin Paul Ambrose, (2020) Use of pre-operative Procalcitonin and C-reactive Protein measurements as biomarker of post-operative infective complications of Pancreaticoduodenectomy. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Pancreaticoduodenectomy is a major abdominal operation associated with high morbidity. Infective complications are a common cause of the morbidity associated with this operation. Early prediction of the infectious complication could help in taking preventive measures for the same, especially in the preoperative setting. Procalcitonin and C-reactive protein have been widely considered as biomarkers of sepsis and infections. Finding an association between preoperative values of Procalcitonin, C-reactive protein, and the postoperative complications, may help reduce the morbidity associated with the infectious complications following pancreaticoduodenectomy. Currently, there are no preoperative markers to identify the likelihood of developing postoperative infective complications. Hence, this study was undertaken to assess the use of preoperative Procalcitonin and C-reactive protein measurements as a biomarker of postoperative infective complications of Pancreaticoduodenectomy. METHODS: A prospective observational study was conducted on 50 patients who underwent Pancreaticoduodenectomy for various indications, the majority of which was for pancreatic and periampullary malignancy between December 2017 and February 2019. These patients planned for Pancreaticoduodenectomy were tested for serum Procalcitonin and C-reactive protein one day prior to the date of surgery and were postoperatively monitored for sepsis, surgical site infections, pneumonia and urinary tract infection on postoperative days 3, 7, 10 and at discharge. Data collected were entered using software Epidata version 3.1. Analysis was done using software SPSS version 23. Univariate analysis was done using measures of central dispersion for continuous variables and proportions for categorical variables. Bivariate analysis was done using chi-square and Fisher’s Exact Test. RESULTS: Postoperative sepsis was seen among 22 (44%) patients, no specific time point like post-operative day 3, 7, 10 or the time at discharge had increased risk of sepsis. Surgical site infection was seen among 32 (62%) patients of which superficial surgical site infection was more common. Features of sepsis and surgical site infections were found to be more among patients with elevated preoperative C-reactive protein measurements, however, there was no statistically significant association. No statistical significance was established for associations between preoperative measurements of Procalcitonin, C-reactive protein and postoperative infectious complications of Pancreaticoduodenectomy. CONCLUSIONS: The role of preoperative measurements of Procalcitonin and C-reactive protein as a biomarker of postoperative infective complications of Pancreaticoduodenectomy could not be established from this study. The power of the study to have any statistically significant association was limited by a small sample size. Hence, we would recommend this study to be conducted in a larger number of patients over a longer duration and observe the significance if any to reach a statistically significant conclusion.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711458 |
| Uncontrolled Keywords: | Pancreaticoduodenectomy, Procalcitonin, C-reactive protein, preoperative measurements, biomarker, post-operative infective complications. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 12 Feb 2021 16:50 |
| Last Modified: | 12 Feb 2021 16:50 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14066 |
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