Ahmet Burak ÇİFTÇİ, Kürşat YEMEZ, Hüseyin ERASLAN

Pankreatikoduodenektomili hastalarda albümin/globulin oranının postoperatif pankreas fistülünü öngörmedeki rolü

Amaç: Albümin/globulin oranı (AGR), inflamasyon ve bağışıklığın göstergelerinden biridir. Bu oran birçok malign hastalıkta da prognostik öneme sahiptir. Önceki çalışmalar, inflamatuar aracılar ile postoperatif pankreas fistülü (POPF) arasında bir ilişki olduğunu göstermiştir. Bu çalışmada, nispeten yeni bir gösterge olan AGR'nin postoperatif pankreas fistülü (POPF) ile ilişkisinin değerlendirilmesi amaçlandı. Yöntem: 2017 ve 2020 yılları arasında pankreatikoduodenektomi (PD) hastaları geriye dönük olarak analiz edildi ve iki gruba ayrıldı: (1) klinik olarak anlamlı POPF'si (CR-POPF) olan ve olmayan (2). İki grup ameliyat öncesi ve sonrası AGR ve klinik, demografik özellikler açısından karşılaştırıldı. AGR, albümin/ (toplam protein-albümin) olarak hesaplandı ve AGR için kesim noktası Youden indeksine göre belirlendi. Bulgular: PD uygulanan 121 hastanın %21'inde CR-POPF gelişti. Gruplar arasında yaş, cinsiyet, ek hastalık durumu, pankreas kanalı genişliği ve anastomoz tekniği açısından fark bulunmadı. Ameliyat öncesi ve sonrası 3. gün (POD3) albümin seviyeleri ve AGR, CR-POPF grubunda anlamlı derecede düşük bulundu. Çok değişkenli analiz, AGR ve pankreas dokusu sertliğinin POPF gelişimi için bağımsız risk faktörleri olduğunu gösterdi. Sonuç: Düşük AGR, CR-POPF gelişimi için bağımsız bir risk faktörüdür. POPF insidansını azaltmak için bu oran optimal seviyede tutulmalıdır. AGR'nin pankreatikoduodenektomi hastalarında POPF'yi öngörmede yararlı bir araç olarak kullanılması önerilmektedir.

Anahtar Kelimeler:

albumin, albumin/globulin oranı, pankreatikoduodenektomi, postoperatif pankreas fistülü

The role of the albumin/globulin ratio on predicting post-operative pancreatic fistula in pancreaticoduodenectomy patients

Background: The albumin/globulin ratio (AGR) is one of several indicators of inflammation and immunity. This ratio has a prognostic significance in many malignant diseases. Previous studies have demonstrated a relationship between inflammatory mediators and post-operative pancreatic fistula (POPF). This study aimed to evaluate the relationship of AGR, a relatively new indicator, with post-operative pancreatic fistula (POPF). Methods: Pancreaticoduodenectomy (PD) patients between 2017 and 2020 were retrospectively analyzed and divided into two groups: (1) with and (2) without clinically relevant POPF (CR-POPF). The two groups were compared in terms of pre-operative–post-operative AGR and clinicodemographic characteristics. AGR was calculated as albumin/total protein–albumin, and the cutoff point for AGR was determined according to Youden’s index. Results: CR-POPF developed in 21% of 121 patients who underwent PD. No differences between the groups in terms of age, gender, comorbid disease status, pancreatic duct width, and anastomosis technique were found. Pre- and post-operative day-3 (POD3) albumin levels and AGR were found to be significantly lower in the CR-POPF group. Multivariate analysis showed that AGR and pancreatic tissue stiffness are independent risk factors for POPF development. Conclusion: Low AGR is an independent risk factor for the development of CR-POPF. To reduce the incidence of POPF, this ratio should be maintained at an optimal level. The use of AGR as a useful tool for predicting POPF in pancreaticoduodenectomy patients is suggested.

Keywords:

albumin, albumin/globulin ratio, pancreaticoduodenectomy, postoperative pancreatic fistula,

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