Plasma apolipoprotein A2 isoforms predict the development of pancreatic fistula following distal pancreatectomy

Table 1 Baseline characteristics of patients stratified by preoperative apolipoprotein A2-AT/AT levels, mean ± SD/n (%)

Variable	n	ApoA2-AT < 58.17 µg/mL, n = 34	ApoA2-AT ≥ 58.17 µg/mL, n = 17	P value1
Age, years (continuous)	51	66.3 ± 14.6	65.5 ± 16.6	0.873
Age, years (categorical)	51			> 0.999
< 65		13 (38.2)	6 (35.3)
≥ 65		21 (61.8)	11 (64.7)
Sex	51			> 0.999
Female		15 (44.1)	8 (47.1)
Male		19 (55.9)	9 (52.9)
BMI, kg/m2	51	21.9 ± 4.1	21.7 ± 3.9	0.907
Diabetes	51	10 (29.4)	5 (29.4)	> 0.999
History of epigastric laparotomy	51	4 (11.8)	4 (23.5)	0.416
History of cancer	51	9 (26.5)	6 (35.3)	0.532
Smoking	51			> 0.999
No		16 (47.1)	8 (47.1)
Yes		15 (44.1)	7 (41.2)
Unknown		3 (8.8)	2 (11.8)
Alcohol	51			0.229
No		18 (52.9)	10 (58.8)
Yes		11 (32.4)	2 (11.8)
Unknown		5 (14.7)	5 (29.4)
CA19-9, U/mL	50	73.8 ± 174.3	49.0 ± 149.0	0.602
Missing		1	0
CEA, ng/mL	50	3.1 ± 2.0	3.3 ± 2.0	0.749
Missing		1	0
Total cholesterol	49	178.6 ± 37.1	200.4 ± 42.3	0.090
Missing		1	1
Amylase	51	104.0 ± 96.3	101.5 ± 33.4	0.890
Alb, g/dL	51	4.0 ± 0.6	4.3 ± 0.7	0.249
Splenectomy	51	28 (82.4)	12 (70.6)	0.472
ASA	51			0.687
1		1 (2.9)	1 (5.9)
2		28 (82.4)	15 (88.2)
3		5 (14.7)	1 (5.9)
Pancreatic parenchymal thickness, mm (continuous)	51	10.8 ± 3.4	11.6 ± 4.0	0.482
Pancreatic parenchymal thickness, mm (categorical)	51			> 0.999
< 12		23 (67.6)	11 (64.7)
≥ 12		11 (32.4)	6 (35.3)
MPD diameter, mm (continuous)	51	2.4 (1.7)	2.6 (1.4)	0.645
MPD diameter, mm (categorical)	51			0.545
< 3		22 (64.7)	9 (52.9)
≥ 3		12 (35.3)	8 (47.1)
Surgical method	51			0.129
Laparoscopic approach		18 (52.9)	13 (76.5)
Open approach		6 (17.6)	0 (0.0)
Robot approach		10 (29.4)	4 (23.5)
Surgical time, minutes	51	376.8 ± 220.9	272.0 ± 36.9	0.011
Blood loss, mL	51	443.0 ± 698.1	144.5 ± 221.2	0.028
Blood transfusion	51	5 (14.7)	1 (5.9)	0.650
Preoperative chemotherapy	51	11 (32.4)	0 (0.0)	0.009

¹Welch’s two-sample t-test or Fisher’s exact test.

BMI: Body mass index; CA19-9: Carbohydrate antigen 19-9; CEA: Carcinoembryonic antigen; Alb: Albumin; ASA: American Society of Anesthesiologists; MPD: Main pancreatic duct; ApoA2-AT: Apolipoprotein A2-AT/AT.

Table 2 Incidence of postoperative pancreatic fistula according to preoperative apolipoprotein A2-AT/AT expression level, n (%)

Feature	n	ApoA2-AT < 58.17 µg/mL, n = 34	ApoA2-AT ≥ 58.17 µg/mL, n = 17	P value
	51			< 0.001
POPF (+)		13 (38.2)	17 (100.0)
POPF (-)		21 (61.8)	0 (0.0)

¹Pearson’s χ² test.

ApoA2-AT: Apolipoprotein A2-AT/AT; POPF: Postoperative pancreatic fistula.

Table 3 Univariate logistic regression analysis of risk factors for postoperative pancreatic fistula

Variable	n	OR	95%CI	P value
ApoA2-AT, μg/mL	51
< 58.17		Reference
≥ 58.17		55.7	6.58-7319.4	< 0.001
Age, years	51
< 65		Reference
≥ 65		0.52	0.15-1.68	0.286
Sex	51
Female		Reference
Male		2.30	0.75-7.41	0.151
BMI, kg/m2	51
< 25		Reference
≥ 25		1.83	0.44-9.40	0.427
Pancreatic parenchymal thickness, mm	51
< 12		Reference
≥ 12		0.70	0.21-2.29	0.547
MPD diameter, mm	51
< 3		Reference
≥ 3		1.08	0.35-3.48	0.891

ApoA2-AT: Apolipoprotein A2-AT/AT; BMI: Body mass index; MPD: Main pancreatic duct; CI: Confidence interval; OR: Odds ratio.

Table 4 Multivariate logistic regression analysis of risk factors for postoperative pancreatic fistula, adjusted by potential confounding factors

Variable	n	OR	95%CI	P value
ApoA2-AT, μg/mL	51
< 58.17		Reference
≥ 58.17		163.39	10.50-35710.29	< 0.001
Age, years	51
< 65		Reference
≥ 65		0.29	0.05-1.38	0.122
Sex	51
Female		Reference
Male		7.10	1.38-57.93	0.017
BMI, kg/m2	51
< 25		Reference
≥ 25		2.96	0.37-37.30	0.309
Pancreatic parenchymal thickness, mm	51
< 12		Reference
≥ 12		0.19	0.02-1.07	0.060
MPD diameter, mm	51
< 3		Reference
≥ 3		1.07	0.21-5.74	0.932

ApoA2-AT: Apolipoprotein A2-AT/AT; BMI: Body mass index; MPD: Main pancreatic duct; CI: Confidence interval; OR: Odds ratio.