C-reactive protein is superior to white blood cell count for early detection of complications after pancreatoduodenectomy: a retrospective multicenter cohort study

HPB (Oxford). 2020 Oct;22(10):1504-1512. doi: 10.1016/j.hpb.2020.02.005. Epub 2020 Mar 11.


Background: Early detection of major complications after pancreatoduodenectomy could improve patient management and decrease the "failure-to-rescue" rate. In this retrospective cohort study, we aimed to compare the value of C-reactive protein (CRP) and white blood cell count (WBC) in the early detection of complications after pancreatoduodenectomy.

Methods: We assessed pancreatoduodenectomies between January 2012 and December 2017. Major complications were defined as grade III or higher according to the Clavien-Dindo classification. Postoperative pancreatic fistula (POPF) was a secondary endpoint. ROC-curve and logistic regression analysis were performed for CRP and WBC. Results were validated in an external cohort.

Results: In the development cohort (n = 285), 103 (36.1%) patients experienced a major complication. CRP was superior to WBC in detecting major complications on postoperative day (POD) 3 (AUC:0.74 vs. 0.54, P < 0.001) and POD 5 (AUC:0.77 vs. 0.68, P = 0.031), however not on POD 7 (AUC:0.77 vs. 0.76, P = 0.773). These results were confirmed in multivariable analysis and in the validation cohort (n = 202). CRP was also superior to WBC in detecting POPF on POD 3 (AUC: 0.78 vs. 0.54, P < 0.001) and POD 5 (AUC: 0.83 vs. 0.71, P < 0.001).

Conclusion: CRP appears to be superior to WBC in the early detection of major complications and POPF after pancreatoduodenectomy.

Publication types

  • Multicenter Study

MeSH terms

  • C-Reactive Protein* / analysis
  • Humans
  • Leukocyte Count
  • Pancreatic Fistula / diagnosis
  • Pancreatic Fistula / etiology
  • Pancreaticoduodenectomy* / adverse effects
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Retrospective Studies


  • C-Reactive Protein