Perioperative H-FABP and Its Association with Postoperative Morbidity Following Pancreatic Resection: A Prospective Observational Study

Background and Objectives: Postoperative morbidity presents a significant challenge in pancreatic surgery. Biomarkers that enable early detection of complications could enhance postoperative monitoring and allow for timely intervention. This study aimed to assess whether perioperative concentrations of heart-type fatty acid–binding protein (H-FABP) are linked to severe postoperative complications and pancreas-specific morbidity following pancreatic resection. Methods: Serum H-FABP levels were measured preoperatively and on postoperative days 2, 4, and 6. Results: Among the 53 patients (33 women [62.3%]) included in the final analysis, those with malignant disease exhibited significantly higher preoperative H-FABP concentrations (median, 1320 vs. 630 ng/L; p = 0.015), as did patients classified as ASA III (median, 1309 vs. 620 ng/L; p = 0.025) and aged 70 years or older (median = 1431 vs. 550 ng/L; p < 0.001). Elevated postoperative H-FABP levels were associated with severe complications, with notable increases observed on postoperative day (POD) 2 (p = 0.026), POD4 (p = 0.022), and POD6 (p = 0.015). Exploratory ROC analysis indicated moderate discrimination for severe complications (AUC, 0.70, 0.71, and 0.73, respectively). No significant differences in postoperative H-FABP levels were found among patients with clinically relevant postoperative pancreatic fistula, postpancreatectomy acute pancreatitis and postpancreatectomy hemorrhage. Conclusions: Exploratory comparisons at individual time points showed higher postoperative concentrations of H-FABP in patients with severe complications; however, the main longitudinal analysis using a mixed-effects model did not reveal a statistically significant group effect or an interaction between group and time. Larger prospective multicenter studies are required to validate its clinical utility.