Utility of preoperative systemic inflammatory biomarkers in predicting postoperative complications after pancreaticoduodenectomy: Literature review and single center experience

BACKGROUND The role of preoperative inflammatory biomarkers(PIBs)in predicting postoperative morbidity has been assessed in colorectal and otorhinolaryngeal surgery.However,data regarding the role that preoperative inflammatory biomarkers have on morbidity after pancreaticoduodenectomiy(PD)are less consistent.AIM To assess the utility of PIBs in predicting postoperative complications after pancreaticoduodenectomy.METHODS A database of 317 consecutive pancreaticoduodenectomies performed from April 2003 to November 2018 has been retrospectively analyzed.Data regarding preoperative neutrophil-to-lymphocyte ratio(NLR),derived NLR and C-reactive protein(CRP),and postoperative complications of 238 cases have been evaluated.Exclusion criteria were:age<18-years-old,previous neoadjuvant treatment,absence of data about PIBs,concomitant hematological disorders,and presence of active infections at the moment of the surgery.PIBs were compared using Mann-Whitney’s test and receiver operating characteristic(ROC)analysis was performed to define the cutoffs.The positive predictive value(PPV)was computed to evaluate the probability to develop complication.P-values<0.05 were considered statistically significant.RESULTS According to the literature findings,only four papers have been published reporting the relation between the inflammatory biomarkers and PD postoperative morbidity.A combination of preoperative and postoperative inflammatory biomarkers in predicting complications after PD and the utility of preoperative NLR in the development of postoperative pancreatic fistula(POPF)have been reported.The combination of PIBs and postoperative day-1 drains amylase has been reported to predict the incidence of POPF.According to our results,CRP values were significantly different between patients who had/did not have postoperative complications and abdominal collections(P<0.05).Notably,patients with preoperative CRP>8.81 mg/dL were at higher risk of both overall complications and abdominal collections(respectively P=0.0037,PPV=0.95,negative predictive value[NPV]=0.27 and P=0.016,PPV=0.59,NPV=0.68).Preoperative derived neutrophil-to-lymphocyte ratio(dNLR)(cut off>1.47)was also a predictor of abdominal collection(P=0.021,PPV=0.48,NPV=0.71).Combining CRP and dNLR,PPV increased to 0.67.NLR(cut off>1.65)was significantly associated with postoperative hemorrhage(P=0.016,PPV=0.17,NPV=0.98).CONCLUSION PIBs may predict complications after PD.During postoperative care,PIB levels could influence decisions regarding the timing of drains removal and the selection of patients who might benefit from second level diagnostic exams.

Wrist circumference: A new marker for insulin resistance in African women with polycystic ovary syndrome

BACKGROUND Insulin resistance(IR)is the main complication found in 35%-80%of women with polycystic ovary syndrome(PCOS).However,there is no definite consensus regarding which marker to use for its assessment in PCOS women.Research has shown that hyperinsulinemia is correlated with increased bone mass.Given that most women with PCOS are insulin resistant,which is independent from body fat and characterized by hyperinsulinemia,it could be hypothesized that there would be an increased bone mass in the patient as a result.Subsequently,increased bone mass could be measured using the wrist circumference method.AIM To assess the wrist circumference as an easy-to-detect marker of IR in Congolese women with PCOS.METHODS Seventy-two Congolese women with PCOS and seventy-one controls from the same ethnic group,were enrolled in the study(mean age 24.33±5.36 years).Fasting biochemical parameters,and the Homeostasis Model Assessment of insulin resistance(HOMA-IR)and body composition were evaluated.The nondominant wrist circumference was measured manually,as was the waist circumference(WC),hip circumference,height and weight.Calculated measures included evaluation of body mass index(BMI),Waist-to-Height(WHtR)and Waist-to-hip ratio(WHR).In addition,body composition was assessed by Bioelectrical Impedance Analysis using a body fat analyzer.RESULTS The non-dominant wrist circumference was more closely correlated with HOMAIR(r=0.346;P=0.003)and was the best anthropometrical marker correlated with IR(P=0.011)compared with other anthropometrical markers in women with PCOS:Dominant Wrist Circumference(r=0.315;P=0.007),Waist Circumference(WC)(r=0.259;P=0.028),BMI(r=0.285;P=0.016),WHR(r=0.216;P=0,068)and WHtR(r=0.263;P=0.027).The diagnostic accuracy of the non-dominant wrist circumference for the presence or absence of IR using Receiver-operating characteristic(ROC)curve analysis showed that the area under the ROC curve was 0.72.A cutoff value for the non-dominant wrist circumference of 16.3 cm was found to be the best predictor of IR in Congolese women with PCOS.CONCLUSION Non-dominant wrist circumference is,to date,the best anthropometrical marker of IR in Sub-Saharan African women with PCOS.It could be suggested as an easy-to-detect marker for assessing IR.