Predicting pancreatic fistula post-splenectomy in cirrhosis with splenomegaly: Risk factors and nomogram validation

Table 1 Comparison of demographic and clinical characteristics between patients with and without pancreatic fistula after splenectomy, mean ± SD

Variables	CR-POPF group (n = 6)	Non-CR-POPF group (n = 180)	P value
Age (years)	33.17 ± 21.78	35.56 ± 14.01	0.687
Gender (male/female)			0.701
Male	4	102
Female	2	78
Alcohol consumption			0.401
Yes	1	14
No	5	166
Smoking			0.185
Yes	2	23
No	4	157
Hypertension			0.552
Yes	1	22
No	5	158
Coronary artery disease			0.310
Yes	1	10
No	5	170
Dyslipidemia			0.518
Yes	1	20
No	5	160
Diabetes			0.249
Yes	2	28
No	4	152
BMI (kg/m2)	26.90 (24.33, 28.53)	22.00 (20.30, 23.20)	0
ASA classification			0.150
I	3	131
II	2	39
III	1	10
WBC (× 109/L)	2.29 (1.27, 3.64)	2.35 (1.72, 3.02)	0.884
RBC (× 1012/L)	3.67 ± 0.65	3.87 ± 0.59	0.470
HGB (g/L)	102.50 ± 10.62	109.31 ± 18.80	0.379
PLT (× 109/L)	43.50 (33.00, 65.50)	41.50 (32.00, 53.75)	0.522
ALT (U/L)	26.40 (17.75, 45.50)	25.05 (19, 33.95)	0.920
AST (U/L)	26.50 (17.50, 42.50)	28.50 (21, 36.75)	0.934
TB (μmol/L)	14.63 (8.88, 17.85)	17.90 (12.88, 27.23)	0.123
ALB (g/L)	35.95 (30.25, 40.43)	36.20 (32.90, 39.60)	0.710
PT (seconds)	11.75 (10.93, 12.20)	13.50 (12.50, 14.88)	0.020
INR	1.09 (1.02, 1.18)	1.23 (1.11, 1.36)	0.067
APTT (seconds)	30.45 (27.73, 32.63)	34.75 (31.70, 38.28)	0.078
D-Dimer (mg/L FEU)	0.31 (0.19, 0.57)	0.24 (0.19, 0.59)	0.611
Child-Pugh classification			0.910
A	5	140
B	1	36
C	0	4
Ascite			0.206
No ascites	3	132
Mild ascites	2	24
Moderate to severe ascites	1	24
Splenic length (mm)	203.17 ± 7.41	187.58 ± 27.20	0.164
Splenic thickness (mm)	75.67 ± 8.55	63.56 ± 11.10	0.009
Portal vein diameter (mm)	14.00 (13.00, 15.50)	13.00 (12.00, 15.00)	0.380
Splenic vein diameter (mm)	15.00 (15.00, 16.25)	13.00 (11.00, 15.00)	0.038
Main pancreatic duct diameter (mm)	2.25 (1.85, 4.28)	2.70 (2.20, 3.10)	0.959
Pancreatic CT value (HU)	34.00 (30.25, 41.25)	35.00 (29.25, 39.00)	0.709
Surgical method			0.917
Splenectomy	5	147
Devascularization	1	33
Splenic pedicle vessel division method			0.092
First-order splenic pedicle vessel division	5	79
Second-order splenic pedicle vessel division	1	101
Stapler division			0.018
Yes	5	58
No	1	122
Pancreatic texture			0.048
Soft	4	87
Firm	1	97
Hard	1	2
Drainage fluid amylase	20762.50 (10877.25, 42335.75)	216.00 (100.00, 441.25)	0
Hospital stay (days)	14.00 (11.75, 33.25)	14.00 (12.00, 17.00)	0.041
Blood loss (mL)	395.00 (290.00, 450.00)	230.00 (200.00, 350.00)	0.144

CR-POPF: Clinically relevant postoperative pancreatic fistula; BMI: Body mass index; ASA: Acetylsalicylic acid; WBC: White blood cell; RBC: Red blood cell; HGB: Hemoglobin; PCT: Plateletcrit; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; ALB: Albumin; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio; FEU: Fibrinogen equivalent unit; CT: Computed tomography; HU: Hounsfield unit.

Table 2 Comparison of general data among different pancreatic fistula grades after surgery

Variables	Biochemical leak (n = 21)	Grade B (n = 4)	Grade C (n = 2)	P value
Age (years, mean ± SD)	34.19 ± 12.76	29.25 ± 20.85	41 ± 29.70	0.664
Gender (male/female)				0.648
Male	9	3	1
Female	12	1	1
Alcohol consumption				0.545
Yes	2	1	0
No	19	3	2
Smoking				0.813
Yes	9	1	1
No	12	3	1
Hypertension				0.338
Yes	7	0	1
No	14	4	1
Coronary artery disease				0.545
Yes	2	1	0
No	19	3	2
Dyslipidemia				0.752
Yes	4	1	0
No	17	3	2
Diabetes				0.542
Yes	4	1	1
No	17	4	1
BMI (kg/m2)	22.60 (21.15, 23.20)	26.90 (24.95, 28.78)	26.05 (23.80, 26.05)	0
ASA				0.677
I	14	2	1
II	5	1	1
III	2	1	0
WBC (× 109/L)	2.67 (2.05, 3.94)	1.67 (1.24, 2.41)	4.04 (3.24, 4.04)	0.190
RBC (× 1012/L)	3.89 ± 0.59	3.33 ± 0.15	4.42 ± 0.70	0.082
HGB (g/L)	112.05 ± 19.60	98.25 ± 5.91	111 ± 15.56	0.397
PLT (× 109/L)	51.00 (32.00, 55.50)	49.50 (34.00, 72.50)	41.50 (33.00, 41.50)	0.760
ALT (U/L)	24.00 (16.80, 38.00)	26.40 (19.75, 53.45)	28.50 (17.00, 28.50)	0.962
AST (U/L)	28.00 (21.00, 35.50)	31.00 (19.25, 49.50)	23.00 (16.00, 23.00)	0.570
TB (μmol/L)	16.20 (13.05, 31.17)	11.60 (7.03, 15.25)	18.70 (17.00, 18.70)	0.392
ALB (g/L)	38.90 (33.85, 40.75)	31.95 (29.15, 37.68)	41.45 (38.80, 41.45)	0.259
PT (seconds)	13.30 (12.00, 13.75)	11.80 (10.48, 12.60)	11.55 (11.20, 11.55)	0.155
INR	1.16 (1.05, 1.26)	1.14 (0.98, 1.21)	1.06 (1.04, 1.06)	0.423
APTT (seconds)	35.20 (31.80, 37.80)	30.05 (26.78, 33.40)	30.60 (29.00, 30.60)	0.061
D-Dimer (mg/L FEU)	0.23 (0.19, 0.56)	0.24 (0.19, 0.79)	0.38 (0.32, 0.38)	0.872
Child-Pugh classification				0.752
A	17	3	2
B	4	1	0
C		0	0
Ascite				0.227
No ascites	17	2	1
Mild ascites	2	1	1
Moderate to severe ascites	2	1	0
Splenic length (mm)	188.62 ± 19.74	207 ± 5.72	195.5 ± 0.71	0.192
Splenic thickness (mm)	67.71 ± 11.89	76 ± 2.94	75 ± 18.38	0.344
Portal vein diameter (mm)	15.00 (13.00, 16.00)	14.00 (13.25, 14.75)	15.00 (13.00, 15.00)	0.773
Splenic vein diameter (mm)	15.00 (14.00, 16.00)	15.00 (15.00, 16.50)	15.50 (15.00, 15.50)	0.828
Main pancreatic duct diameter (mm)	2.80 (2.05, 3.05)	2.25 (1.93, 3.70)	3.25 (1.70, 3.25)	0.742
Pancreatic CT value (HU)	32.00 (27.50, 35.00)	32.50 (28.75, 37.75)	41.00 (34.00, 41.00)	0.093
Surgical method				0.162
Splenectomy	20	4	1
Devascularization	1	0	1
Splenic pedicle vessel division method				0.733
First-order splenic pedicle vessel division	16	3	2
Second-order splenic pedicle vessel division	5	1	0
Stapler division				0.497
Yes	12	3	2
No	9	1	0
Pancreatic texture				0.008
Soft	16	3	0
Firm	5	1	0
Hard	0	0	2
Drainage fluid amylase	1485.00 (1294.50, 1961.00)	12197.50 (10377.75, 24509.75)	54671.50 (30000.00, 54671.50)	0
Hospital stay (days)	14.00 (12.00, 16.50)	22.50 (11.25, 33.75)	14.00 (14.00, 14.00)	0.079
Blood loss (mL)	340.00 (300.00, 372.50)	380.00 (230.00, 447.50)	400.00 (350.00, 400.00)	0.460

BMI: Body mass index; ASA: Acetylsalicylic acid; WBC: White blood cell; RBC: Red blood cell; HGB: Hemoglobin; PCT: Plateletcrit; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; TB: Total bilirubin; ALB: Albumin; PT: Prothrombin time; APTT: Activated partial thromboplastin time; INR: International normalized ratio; FEU: Fibrinogen equivalent unit; CT: Computed tomography; HU: Hounsfield unit.

Table 3 Multivariate least absolute shrinkage and selection operator-penalized logistic regression analysis of risk factors for pancreatic fistula after splenectomy

Variables	B	SE	Wald	df	Significance	Exp (B)	Lower 95%CI	Upper 95%CI
BMI	1.275	0.577	4.887	1	0.027	3.578	1.156	11.080
PT	-2.531	1.482	2.916	1	0.088	0.080	0.004	1.453
Splenic thickness	0.223	0.107	4.352	1	0.037	1.250	1.014	1.542
Stapler division	1.155	1.493	0.549	1	0.439	3.175	0.170	59.227

B: Unstandardized beta coefficient; SE: Standard error; CI: Confidence interval; Exp: Exponentiated beta coefficient; BMI: Body mass index; PT: Prothrombin time.