Combined prognostic nutritional index ratio and serum amylase level during the early postoperative period predicts pancreatic fistula following pancreaticoduodenectomy

BACKGROUND: The aim of this study was to investigate the usefulness of the range of change in prognostic nutritional index (PNI) during the early postoperative period as a predictor of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy. METHODS: Data were retrospectively analyzed for 192 patients who underwent pancreaticoduodenectomy. Univariate and multivariate logistic regression analyses were used to evaluate perioperative variables. PNI(P3-Pre) ratio represented the range of change in PNI from before surgery to postoperative day (POD) 3, PNI(P1-Pre) ratio represented the range of change in PNI from before surgery to POD 1, and PNI(P3-P1) ratio represented the range of change in PNI from POD 1 to POD 3. RESULTS: The area under the curve (AUC) for PNI(P3-P1) for prediction of POPF following pancreaticoduodenectomy was 0.683 (P < 0.001), which was highest among PNI ratios and higher than PNI on POD 3. The AUC for serum amylase level on POD 1 was 0.704 (P < 0.001), which was superior to the corresponding AUC on POD 3. The AUC for the combination of PNI(P3-P1) ratio and serum amylase level on POD 1 for prediction of POPF was higher than the AUC of either indicator alone (0.743, P < 0.001). The combination of PNI(P3-P1) ratio and serum amylase level on POD 1 was an independent predictor of POPF following pancreaticoduodenectomy (P = 0.018). CONCLUSIONS: The combination of the range of change in PNI from POD 1 to POD 3 and serum amylase levels on POD 1 may be useful for prediction of POPF following pancreaticoduodenectomy.