Correlation analysis between preoperative inflammation-nutrition-related indices and the risk of pancreatic fistula formation following distal pancreatectomy
- 1Pancreatic Disease Center, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
- 2Department of General Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
Abstract
Objective: To investigate the associations of preoperative C-reactive protein-to-albumin ratio (CAR), inflammatory burden index (IBI), and C-reactive protein-albumin-lymphocyte (CALLY) index with clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP), and to compare their predictive value, providing a reference for preoperative risk assessment. Methods: We retrospectively included 300 patients who underwent DP between June 2022 and June 2024. CR-POPF was defined according to the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria as Grade B or Grade C POPF. Multivariable logistic regression was used to evaluate the associations of CAR, IBI, and CALLY with CR-POPF, and restricted cubic splines were used to assess dose-response relationships. Predictive performance of the preoperative baseline model and models incorporating each index was compared using receiver operating characteristic (ROC) analysis with DeLong tests, calibration assessment, Brier scores, decision curve analysis, and 1,000-resample bootstrap internal validation. Results: CR-POPF occurred in 84 of 300 patients (28.0%); among these events, 81 (96.4%) were Grade B and 3 (3.6%) were Grade C. In preoperative-adjusted analyses, higher CAR (odds ratio [OR] 230.244, 95% confidence interval [CI] 45.053–1176.652; P < 0.001) and IBI (OR 1.015, 95% CI 1.006–1.024; P < 0.001) were associated with higher odds of CR-POPF, whereas higher CALLY was associated with lower odds (OR 0.979, 95% CI 0.967–0.991; P = 0.001). The baseline model had an area under the ROC curve (AUC) of 0.786 (95% CI 0.726–0.845). Adding CAR increased the AUC to 0.894 (95% CI 0.857–0.931; P < 0.001 vs baseline), compared with 0.821 for IBI (P = 0.004) and 0.827 for CALLY (P = 0.016). Bootstrap-corrected AUCs were 0.763 for the baseline model, 0.879 for baseline+CAR, 0.796 for baseline+IBI, and 0.805 for baseline+CALLY. The CAR-extended model also had the lowest Brier score (0.120) and showed the greatest net benefit across much of the examined threshold range. Conclusions: Preoperative CAR, IBI, and CALLY were associated with CR-POPF after DP. Among the three indices, CAR showed the strongest predictive performance when added to the preoperative clinical model. These findings may provide a reference for preoperative risk assessment, although external validation is needed.
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BibTeX
@article{wu2026correlation,
title = {{Correlation analysis between preoperative inflammation-nutrition-related indices and the risk of pancreatic fistula formation following distal pancreatectomy}},
author = {Shiwei Wu and Dongxing Zhang and Yizhang Zhu and Ning Li and Daobin Wang and Jiayue Zou and Xiaoyuan Hu and Jiawei Jin and Jun He and Xiaofeng Xue and Lei Qin},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360418},
url = {https://doi.org/10.1371/journal.pone.0360418},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Correlation analysis between preoperative inflammation-nutrition-related indices and the risk of pancreatic fistula formation following distal pancreatectomy
AU - Shiwei Wu
AU - Dongxing Zhang
AU - Yizhang Zhu
AU - Ning Li
AU - Daobin Wang
AU - Jiayue Zou
AU - Xiaoyuan Hu
AU - Jiawei Jin
AU - Jun He
AU - Xiaofeng Xue
AU - Lei Qin
PY - 2026
DA - 2026/10/09
JO - PLOS One
DO - 10.1371/journal.pone.0360418
UR - https://doi.org/10.1371/journal.pone.0360418
AB - Objective: To investigate the associations of preoperative C-reactive protein-to-albumin ratio (CAR), inflammatory burden index (IBI), and C-reactive protein-albumin-lymphocyte (CALLY) index with clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP), and to compare their predictive value, providing a reference for preoperative risk assessment. Methods: We retrospectively included 300 patients who underwent DP between June 2022 and June 2024. CR-POPF was defined according to the 2016 International Study Group of Pancreatic Surgery (ISGPS) criteria as Grade B or Grade C POPF. Multivariable logistic regression was used to evaluate the associations of CAR, IBI, and CALLY with CR-POPF, and restricted cubic splines were used to assess dose-response relationships. Predictive performance of the preoperative baseline model and models incorporating each index was compared using receiver operating characteristic (ROC) analysis with DeLong tests, calibration assessment, Brier scores, decision curve analysis, and 1,000-resample bootstrap internal validation. Results: CR-POPF occurred in 84 of 300 patients (28.0%); among these events, 81 (96.4%) were Grade B and 3 (3.6%) were Grade C. In preoperative-adjusted analyses, higher CAR (odds ratio [OR] 230.244, 95% confidence interval [CI] 45.053–1176.652; P < 0.001) and IBI (OR 1.015, 95% CI 1.006–1.024; P < 0.001) were associated with higher odds of CR-POPF, whereas higher CALLY was associated with lower odds (OR 0.979, 95% CI 0.967–0.991; P = 0.001). The baseline model had an area under the ROC curve (AUC) of 0.786 (95% CI 0.726–0.845). Adding CAR increased the AUC to 0.894 (95% CI 0.857–0.931; P < 0.001 vs baseline), compared with 0.821 for IBI (P = 0.004) and 0.827 for CALLY (P = 0.016). Bootstrap-corrected AUCs were 0.763 for the baseline model, 0.879 for baseline+CAR, 0.796 for baseline+IBI, and 0.805 for baseline+CALLY. The CAR-extended model also had the lowest Brier score (0.120) and showed the greatest net benefit across much of the examined threshold range. Conclusions: Preoperative CAR, IBI, and CALLY were associated with CR-POPF after DP. Among the three indices, CAR showed the strongest predictive performance when added to the preoperative clinical model. These findings may provide a reference for preoperative risk assessment, although external validation is needed.
SN - 1932-6203
ER -