Diagnostic value of systemic immune-inflammation index in postoperative pancreatic fistula after laparoscopic pancreaticoduodenectomy
Objective To evaluate the diagnostic value of systemic immuno inflammatory index(SII)in pancreatic fistula after laparoscopic pancre-aticoduodenectomy(LPD).Methods A total of 306 patients receiving LPD in the Department of General Surgery,Beijing Friendship Hospital,Cap-ital Medical University from January 2018 to June 2023 were selected.Basic data of patients were collected and SII of patients three days before surgery was calculated according to the formula(platelet count × neutrophil/lymphocyte).According to the diagnostic criteria and grading of pan-creatic fistula of the International Pancreatic Surgery Study Group in 2016,the patients were divided into clinically relevant pancreatic fistula(CRPF)group 31 cases and non-CRPF group 275 cases.Risk factors affecting the occurrence of postoperative pancreatic fistula in patients were screened by univariate and multivariate regression analysis,and receiver operating characteristic(ROC)curves for postoperative pancreatic leakage by indices of triglycerides(TG),serum albumin(Alb),and SII and assessment of their diagnostic value were evaluated.Results In this study,31 pa-tients(10.2%)developed CRPF,of which 24 patients with grade B pancreatic fistula and seven patients with grade C pancreatic fistula.Univariate analysis found that neutrophil rate(NEU-R)and TG levels in the CRPF group were higher than in the non-CRPF group,and serum Alb level was lower than in the non-CRPF group(P<0.05).The SII was in the CRPF group higher than in the non-CRPF group(P<0.05).Multifactorial regres-sion analysis revealed that Alb,TG and SII were risk factors for the development of pancreatic fistula after LPD,and Alb was an independent pro-tective factor for the development of pancreatic fistula after LPD(P<0.05).The AUC value of SII was 0.945.The AUC value of TG was 0.911,95%CI(0.918-0.971),and the index of Yoden was 0.733,the cutoff value was 5.62 mmol/L,Z=4.78,P<0.001.The AUC value for Alb was 0.771,95%CI(0.674-0.867),Yoden index was 0.515,and the cutoff value was 35.1 g/L,Z=4.34,P<0.001.Compared to TG and Alb,the SII curve had the largest area under ROC,and it had higher predictive efficacy.The ROC curves to determine the optimal critical value of SII was 984.6 × 109/L,with a sensitivity of 0.782 and a specificity of 0.736.Conclusion SII is an independent risk factor for pancreatic leakage after LPD,and compared with TG and serum ALB,systemic SII has a higher diagnostic value.
Laparoscopic pancreaticoduodenectomyPancreatic fistulaSystemic immune-inflammation indexC-reactive protein