Potential risk factors for nonalcoholic steatohepatitis related to pancreatic secretions following pancreaticoduodenectomy

Table 1 Preoperative characteristics and laboratory findings for the two groups

	Group A(n = 15)	Group B (n = 178)	P
Gender (M:F), n	7:8	112:66	0.270
Age in years, mean (range)	58.7 (40-74)	61.8 (15-81)	0.295
BMI (kg/m2) ± SD	20.6 ± 2.9	22.0 ± 3.3	0.082
Hepatitis B viral infection (+), n (%)	0 (0)	6 (3.4)	1.000
Type II diabetes, n (%)	2 (13.3)	34 (19.1)	0.582
Alcohol consumption > 150 g/wk, n (%)	3 (20.0)	32 (18.0)	0.738
Biliary drainage, n (%)	4 (26.7)	74 (41.6)	0.245
Albumin/globulin ratio (range)	1.79 (1.2-4.1)	1.53 (0.8-2.4)	0.234
Total cholesterol (mg/dL), mean (range)	209.3 (136-309)	200.6 (73-470)	0.641
Serum amylase (U/L), mean (range)	91.3 (22-263)	129.8 (15-1361)	0.388
Serum lipase (U/L), mean (range)	170.4 (24-707)	336.7 (7-13562)	0.593
AST (U/L), mean (range)	134.3 (11-547)	111.7 (12-1230)	0.621
ALT (U/L), mean (range)	156.1 (11-551)	144.0 (9-1371)	0.826
ALP (U/L), mean (range)	315.9 (64-913)	267.3 (34-2236)	0.518
INR, mean (range)	0.99 (0.85-1.11)	1.07 (0.81-8.78)	0.585
Total bilirubin (mg/dL), mean (range)	5.7 (0.3-18.8)	6.2 (0.2-44.3)	0.799
Fasting glucose (mg/dL), mean (range)	140 (93-150)	135 (47-458)	0.735

BMI: Body mass index; SD: Standard deviation; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase; INR: International normalized ratio.

Table 2 Operative treatments and final pathological findings for the two groups

	Group A(n = 15)	Group B(n = 178)	P
PPPD	12	126	0.482
Whipple’s procedure	3	47
HPD	0	5
Pancreatic cancer	7	50	0.665
Common bile duct cancer	3	45
Ampulla of vater cancer	5	27
Duodenal cancer	0	11
IPMN of pancreas	0	23
NET of pancreas or duodenum	0	3
MCN or SPT of pancreas	0	5
Duodenal GIST	0	2
Hilar cholangiocarcinoma	0	4
Colon cancer with duodenal invasion	0	4
Gallbladder cancer with duodenal invasion	0	1
Pancreatitis	0	3

PPPD: Pylorus-preserving pancreaticoduodenectomy; HPD: Hepato-pancreato-duodenectomy; IPMN: Intraductal papillary mucinous neoplasm; NET: Neuroendocrine tumor; MCN: Mucinous cystic neoplasm; SPT: Solid pseudopapillary tumor; GIST: Gastrointestinal stromal tumor.

Table 3 Pearson’s correlation coefficients for the correlation between postoperative liver function and the difference in the postoperative attenuation values between the spleen and liver (CT_S-L) in all patients

Postoperative liver function test result	γ	P
AST	-0.138	0.056
ALT	-0.149	0.039
ALP	-0.023	0.755

AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; ALP: Alkaline phosphatase.

Table 4 Perioperative clinical variables related to pancreatic secretions

	Group A (n = 15)	Group B (n = 178)	P
Serum amylase1, mean (range)	44.5 (9.0-119.0)	51.4 (6.0-266.0)	0.558
Serum lipase1, mean (range)	31.9 (6.0-266.0)	30.0 (1.0-215.0)	0.793
Pancreatic duct size, mean (range) (mm)	4.5 (2-18)	3.5 (1-11)	0.401
Pancreatic fistula2, n	7	34	0.020
Placement of pancreatic duct stent, n	13	131	0.363
Internal, n	4	95	0.005
External, n	9	36

¹Postoperative day 7;

²Diagnosed according to International study group pancreatic fistula criteria[23].

Table 5 Multivariate analysis of risk factors for the development of steatohepatitis after pancreaticoduodenectomy¹

Variables	HR	95% confidence interval	P
Serum amylase2	0.990	0.973-1.007	0.262
Serum lipase2	1.014	0.986-1.041	0.332
Pancreatic duct size3	0.882	0.635-1.224	0.452
Pancreatic fistula4 (-)	1.000	-	-
Pancreatic fistula4 (+)	3.332	1.075-10.321	0.037
Internal pancreatic duct stenting	1.000	-	-
External pancreatic duct stenting	4.530	1.312-15.643	0.017

¹Analyzed by logistic regression;

²Postoperative day 7;

³Dichotomized for categorical variables using a median split;

⁴Diagnosed according to International study group pancreatic fistula criteria[23]. HR: Hazard ratio.