Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy

Abstract

Background Pancreaticoduodenectomy (PD) has recently been improved due to its increased safety. However, postoperative pancreatic fistula (POPF) remains a lethal complication of PD. Identifying novel clinicophysiological risk factors for POPF during the early post‐PD period would help improve patient morbidity and mortality. Therefore, this retrospective study aimed to evaluate possible risk factors during the early postoperative period after pancreaticoduodenectomy (PD). Methods Data from 349 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups: group A, patients without fistulae or biochemical leaks (288 patients), and group B, those with grade B or C POPF (61 patients). Data on various clinicophysiological parameters, including serum and drain laboratory data, were collected. Univariate and multivariate analyses were performed to evaluate POPF predictors. A predictive nomogram was established for these results. Results Univariate analysis showed that various serum and drain‐related factors, such as white blood cell count, C‐reactive protein levels, drain amylase (DAMY) levels, and drain lipase (DLIP) levels, were possible POPF risk factors. Multivariate analysis confirmed that postoperative day (POD) 1 DLIP levels (hazard ratio, 15.393; p = 0.037) and decreased rate (POD3/1) of DAMY levels (hazard ratio, 4.415; p = 0.028) were independent risk factors. Further, POD1 DLIP levels and decreased rate of DAMY levels were significantly lower in group A than in group B. The accuracy of nomogram was 0.810. Conclusions POD1 DLIP levels (> 245 U/mL) and decreased rate of DAMY levels (> 0.44) were POPF risk factors, making them possible biomarkers for POPF.

Drain fluid biomarkers for the diagnosis of clinically relevant postoperative pancreatic fistula - a diagnostic accuracy systematic review and meta-analysis

“…Most of the included studies reported test accuracy through sensitivity and specificity rather than 2×2 tables. As such, the number of studies for this assessment question may have been understated as this discrepancy often became apparent after adding the number of samples in the 2×2 tables 32 , 40 , 43 . The Deeks’ funnel plots indicated statistically significant publication bias for the pre-POD3 ( P =0.0053) and POD1 drain amylase studies ( P =0.015), demonstrating the importance of including abstracts to encompass the scope of research for early amylase evaluation (Supplementary Figures 6, 7, Supplemental Digital Content 1, http://links.lww.com/JS9/A549 ).…”

“…Due to a paucity of POD3 surgery-specific lipase studies, the accuracy of drain amylase and lipase for PD and DP patients could not be compared. Similarly, as only one study investigated POD1 drain lipase 40 , its accuracy compared to POD1 drain amylase could not be determined, and hence its potential utility as a triage test could not be assessed. Our analyses were also limited by the small number of studies that exclusively enrolled DP patients, preventing us from defining specific diagnostic cut-offs for these patients.…”

“…Suzuki et al . 40 similarly investigated the combination of POD1 drain amylase and lipase in a predictive model which additionally included pancreatic duct diameter and pancreatic texture, returning an accuracy of 0.81. The inclusion of pancreas-specific variables incorporates well-established risk factors and reflects current efforts to accelerate CR-POPF risk prediction through the assessment of intraoperative variables.…”

External validation of risk prediction platforms for pancreatic fistula after pancreatoduodenectomy using nomograms and artificial intelligence

“…The AUC value was 0.744 in the external validation. Another nomogram by Suzuki et al [ 14 ] also included drain fluid lipase level on POD 1 and decreased rate of DFA, which was defined as a change in levels from POD 1 to 3. The accuracy of the nomogram was 0.810, as stated in the study.…”

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

“…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). Tzedakis et al [ 101 ] further considered the evolution of drain lipase and its relation to CR-POPF risk with sustained elevation of drain lipase across POD1 and POD3 having a sensitivity of 0.948 which was then confirmed in their validation cohort.…”