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• W3200721857 abstract "Presenter: Deeksha Kapoor DNB | Medanta - The Medicity Background: Elevated preoperative bilirubin levels and cholangitis have traditionally been associated with postoperative morbidity and death following a pancreatoduodenectomy (PD). However, the impact of liver enzymes on early postoperative mortality after PD is relatively unexplored. Aspartate aminotransferase (AST) and alanine aminotransferase (ALT) are markers of liver cell injury which may be deranged even in the absence of clinical signs of cholangitis. These are commonly performed tests in the preoperative period, however clinical relevance of their derangement has not been discussed in literature previously, neither have they been utilized in the various risk predictive models for PD. We observed an increased complication rate and possibly an increased rate of mortality in patients with deranged liver enzymes, even in the absence of overt cholangitis or very high bilirubin levels. The aim of this study was to assess the impact of preoperative levels of AST and ALT on early deaths following PD. Methods: This is a retrospective analysis of 562 patients who underwent pancreatoduodenectomy between March 2013 to December 2020. Data of clinical, preoperative, intraoperative and postoperative outcomes was obtained from a prospectively maintained database and parameters compared between patients who survived and those who died within 30 days of surgery. Univariate analysis was performed to assess the risk factors associated with early deaths. Receiver Operating Characteristic (ROC) curve was plotted to identify the optimal cut-off values for continuous variables which were significant on univariate analysis. The risk factors for early mortality were computed using a multivariate logistic regression model. Results: Twenty-two (3.9%) patients died within thirty days of the operation. Major morbidity was seen in 12.1% patients. The parameters found significantly associated with early mortality on univariate analysis included ASA status, diabetes mellitus, presence of cardiac comorbidity, preoperative endobiliary stenting, presence of vascular anamoly, development of clinically relevant pancreatic fistula, clinically relevant post pancreatectomy bleed and elevated levels of serum bilirubin, AST and creatinine. Using ROC, optimal cut-off point for serum bilirubin, AST and creatinine were identified at 2.8 mg/dl (AUC=0.654, p=0.004), 106 U/L (AUC=0.667, p=0.017) and 0.9 mg/dl (AUC=0.679, p=0.004) respectively. On multivariate analysis, preoperative elevated levels of AST were independently predictive of 30-day mortality (OR=6.141, 95% CI 2.060-18.305, p=0.001). Other factors predictive of mortality included placement of preoperative endobiliary stent (OR=4.831, 95% CI 1.743-13.392, p=0.002) and development of clinically relevant pancreatic fistula or post pancreatectomy bleed ((OR=3.554, 95% CI 1.044-12.100, p=0.042) and (OR=14.703, 95% CI 3.162-68.363, p=0.001) respectively). Conclusion: Among other known factors associated with early mortality after PD, preoperatively elevated levels of AST emerged as unexplored association. Elevated levels of AST but not ALT may be predictive of early mortality after PD, even in the absence of clinical features of cholangitis." @default.
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• W3200721857 date "2021-01-01" @default.
• W3200721857 modified "2023-09-27" @default.
• W3200721857 title "Can preoperative liver enzymes predict early mortality after pancreatoduodenectomy?" @default.
• W3200721857 doi "https://doi.org/10.1016/j.hpb.2021.06.199" @default.
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