Value of preoperative alanine aminotransferase/aspartate aminotransferase combined with multi-phase CT radiological indicators in predicting clinically relevant pancreatic fistula after pancreaticoduodenectomy
- VernacularTitle:术前ALT/AST联合多期CT影像学指标对胰十二指肠切除术后临床相关胰瘘的预测价值
- Author:
Junhao PAN
1
;
Jian XIN
;
Chunhui WANG
Author Information
- Keywords: Pancreaticoduodenectomy; Computed Tomography; Risk Factors; Pancreatic Fistula; Nomograms
- From: Journal of Clinical Hepatology 2024;40(9):1859-1867
- CountryChina
- Language:Chinese
- Abstract: Objective To investigate the risk factors for clinically relevant postoperative pancreatic fistula(CR-POPF)after pancreaticoduodenectomy(PD),and to establish a predictive model for early identification of CR-POPF.Methods A total of 244 patients who underwent PD in General Hospital of Northern Theater Command from January 2019 to October 2023 were collected,and based on strict inclusion and exclusion criteria,179 patients were finally enrolled in this study.According to the presence or absence of CR-POPF,these patients were divided into non-CR-POPF group with 120 patients and CR-POPF group with 59 patients.Univariate and multivariate logistic regression analyses were used to determine the independent risk factors for CR-POPF,and a nomogram model was established based on such factors.The receiver operating characteristic(ROC)curve was used to assess the predictive performance of the model,the calibration curve was used to evaluate the calibration degree of the model,and the clinical decision curve and the clinical impact curve were used to analyze and validate the clinical application value of the model.The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups;the independent-samples t test was used for comparison of normally distributed continuous data between two groups,and the Mann-Whitney U test was used for comparison of continuous data with skewed distribution between two groups.Results Among the 179 patients,59(33.0%)developed CR-POPF.The multivariate Logistic regression analysis showed that alanine aminotransferase/aspartate aminotransferase(odds ratio[OR]=2.221,P=0.004),main pancreatic duct diameter(OR=0.276,P=0.022),the distance between the peritoneum and the anterior pancreatic neck(OR=1.034,P=0.027),and extracellular volume fraction(OR=0.001,P=0.005)were independent risk factors for CR-POPF.Based on the above four independent risk factors,a nomogram was established to predict CR-POPF after PD,with an area under the ROC curve of 0.837,a sensitivity of 0.932,and a specificity of 0.725.The decision curve and the clinical impact curve also showed that the nomogram had good clinical practicability.Conclusion Preoperative clinical indicators combined with multi-phase CT have a good performance in predicting CR-POPF after PD,which can be used to early identify patients at high risk of pancreatic fistula before surgery and provide further guidance for clinical work.
