Drain Amylase or Lipase for the Detection of POPF—Adding Evidence to an Ongoing Discussion

Abstract

Objectives: A postoperative pancreatic fistula (POPF) is defined as a threefold increase in the amylase concentration in abdominal drains on or after the third postoperative day (POD). However, additional lipase fluid analysis is widely used despite lacking evidence. In this study, drain amylase and lipase levels were compared regarding their value in detecting POPF. Methods: We conducted a retrospective study including all patients who underwent pancreatic resections at our center between 2005 and 2016. Drain fluid analysis was performed from day 2 to 5. Results: 990 patients were included in the analysis. Overall, 333 (34%) patients developed a POPF. The median amylase and lipase concentrations at POD 3 in cases with POPF were 11.55 µmol/(s·L) (≈13 ×-fold increase) and 39 µmol/(s·L) (≈39 ×-fold increase), respectively. Seven patients with subsequent POPF (2%) were missed with amylase analysis on POD 3, but detected using 3-fold lipase analysis. The false-positive rate of lipase was 51/424 = 12%. A cutoff lipase value at POD 3 of > 4.88 yielded a specificity of 94% and a sensitivity of 89% for development of a POPF. Increased body mass index turned out as risk factor for the development of POPF in a multivariable model. Conclusions: Threefold-elevated lipase concentration may be used as an indicator of a POPF. However, the additional detection of POPF using simultaneous lipase analysis is marginal. Therefore, assessment of lipase concentration does not provide added clinical value and only results in extra costs.

Analysis of predictors for postoperative complications after pancreatectomy––what is new after establishing the definition of postpancreatectomy acute pancreatitis (PPAP)?

“…2). The importance of amylase and lipase levels for predicting POPF has been previously reported in another study [21]. We observed in contrast to POPF a significant increase of the lipase levels in association with POH.…”

Dynamic prediction for clinically relevant pancreatic fistula: a novel prediction model for laparoscopic pancreaticoduodenectomy

“…This is possibly due to the fact that there's still no strong consensus about the association between these factors and CR-POPF, which probably leads to the inconsistencies in the prediction models developed recently [9,10,16,18]. However, we noted that the patients who developed CR-POPF tend to have an advanced age [44,45], higher BMI [46,47], softer pancreas [48][49][50], and smaller pancreatic ducts [48,[51][52][53][54][55], were less likely to have diabetes [47,56], and were more likely to have had portal vein resection [57], which are comparable to findings of previous research.…”

Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review

“…Lipase drives intraperitoneal lipolysis which can exacerbate systemic inflammation and trigger multi-organ dysfunction specifically as the subsequent high systemic unsaturated fatty acid levels can cause mitochondrial toxicity[ 127 ], lipotoxicity[ 128 ] and kidney[ 129 , 130 ] or liver damage[ 131 ]. Diagnostic cut-offs have ranged from 4.88 U/L to 1000 U/L with the majority exploring both pancreatoduodenectomy and distal pancreatectomy patients[ 100 - 102 , 132 ]. However, pancreatoduodenectomy[ 97 ] and distal pancreatectomy[ 107 ] exclusive studies have also been conducted.…”

“…However, pancreatoduodenectomy[ 97 ] and distal pancreatectomy[ 107 ] exclusive studies have also been conducted. Amongst these reports, the sensitivity and specificity has ranged from 0.8-0.938 and 0.649-0.95, respectively[ 97 , 100 - 102 , 107 , 132 ]. Suzuki et al [ 133 ] reported POD1 drain lipase levels to be an independent risk factor for CR-POPF ( P = 0.037).…”