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Article . 2024 . Peer-reviewed
License: Elsevier Non-Commercial
Data sources: Crossref
https://dx.doi.org/10.5167/uzh...
Other literature type . 2024
Data sources: Datacite
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Article . 2024
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Discharge C-reactive protein predicts 90-day readmission after pancreatoduodenectomy: a conditional inference tree analysis

Authors: Kristjan Ukegjini; Philip C. Müller; Rene Warschkow; Ignazio Tarantino; Jan P. Jonas; Christian E. Oberkofler; Henrik Petrowsky; +2 Authors

Discharge C-reactive protein predicts 90-day readmission after pancreatoduodenectomy: a conditional inference tree analysis

Abstract

The aim of this study was to assess the predictive value of discharge C-reactive protein (CRP) and white blood cell (WBC) levels for 90-day readmission after pancreatoduodenectomy (PD).A two-centre, retrospective study was performed between 2008 and 2022. Receiver operating characteristic (ROC) curve analysis was used to determine the predictive value of CRP level and WBC count at discharge. A conditional inference tree (CTREE) was constructed to identify combined risks within subgroups using variables associated with readmission.Of 438 patients, 54 (12%) were readmitted. The median WBC count at discharge was comparable between the readmitted and not readmitted groups (9.1 vs. 8.5 G/l). The CRP levels at discharge were predictive of 90-day readmission, with an area under the ROC curve (AUC) of 0.63 (95% CI: 0.55-0.63). A CRP concentration below 105 mg/l ruled out 90-day readmission, with a negative predictive value (NPV) of 90% (95% CI: 81%-95%). CTREE confirmed the diagnostic value of CRP at discharge (AUC = 0.68, 95% CI 0.60-0.68). CTREE additionally identified previous wound infection as a second risk factor for readmission in patients with CRP levels less than 101 mg/l (P = 0.003).CRP levels below 105 mg/l at discharge allow for a safe discharge with a low 90-day readmission rate. Wound infection, but not WBC count, was a positive predictor of 90-day readmission with moderate accuracy, suggesting the need for predischarge imaging for undetected complications in this patient cohort.Our retrospective analysis did not require registration with a publicly accessible registry.

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Keywords

Male, Time Factors, Decision Trees, 610 Medicine & health, Middle Aged, Patient Readmission, Risk Assessment, Patient Discharge, Pancreaticoduodenectomy, Leukocyte Count, C-Reactive Protein, Treatment Outcome, Postoperative Complications, Predictive Value of Tests, Risk Factors, Humans, 2721 Hepatology, 2715 Gastroenterology, Female, Biomarkers, 10217 Clinic for Visceral and Transplantation Surgery, Retrospective Studies, Aged

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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
0
Average
Average
Average
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