Comparison of drain fluid lipase with drain fluid amylase in the context of post-operative pancreatic fistula

Roy, Mereen Susan; Ban, Ee Jun; Mohandas, Shailesh; Mownah, O.; Banerjee, Ahijit; Valente, Roberto; Abraham, Albin; Kocher, Hemant M.; Bhattacharya, Sayantan; Hutchins, Robert

doi:10.1016/j.hpb.2018.06.2334

Cited by 3 publications

(4 citation statements)

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“…We found that whilst both amylase and lipase were good predictors and had high concordance, the overall sensitivity of DFL measurements on both POD 3 and 5 was higher than observed in DFA measurements. A recent small cohort study by Roy et al (14) demonstrated that DFL also correlated with CS‐POPF post pancreatic resection and that at a cut‐off value of 500 units/L DFL was superior to DFA with a sensitivity of 86% and specificity of 95% (compared to a sensitivity of 75% and specificity of 90%). These findings were also noted by Facy et al (11).…”

Section: Discussionmentioning

confidence: 99%

Drain fluid amylase and lipase as a predictive factor of postoperative pancreatic fistula

Koek

Wiegele

Ballal

2021

ANZ Journal of Surgery

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Background: Early detection of a postoperative pancreatic fistula (POPF) may improve outcomes after pancreaticoduodenectomy (PD). The aim was to assess the role of postoperative drain fluid amylase (DFA) and lipase (DFL) measurements as a predictive indicator in the development of POPF. Methods: This retrospective cohort study included all PD procedures performed between 2009 and 2017 at Fremantle and Fiona Stanley Hospital in Western Australia. The DFA and DFL measurements on postoperative day (POD) three and five were correlated with the development of POPF. Results: A total of 169 patients were included in this study with a mean age of 64 AE 11.3 years. Of these, 17 (10.1%) developed a clinically significant POPF. In patients who had both a DFA and DFL measured on both POD 3 and 5, DFA and DFL was significantly higher in patients who developed POPF than those who did not (P < 0.001). In a receiver operating characteristic curve analysis, the most accurate test was POD 3 DFL measurement with an AUC 0.85 (CI 0.75-0.95, P < 0.001). A negative predictive value of 97.4% was observed. DFA and DFL were concordant in 89.2% of cases on POD 3 and 90.6% of cases on POD 5. Conclusion: In this study, DFL measured on POD 3 as a single measurement appears to carry the most benefit in prediction of clinically significant POPF. Reduction to a measurement on this day may lead to a reduction in cost, earlier drain removal and earlier identification of high-risk patients. *P < 0.05 is considered statistically significant.Optimal threshold values obtained via Youdan index.

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Section: Discussionmentioning

confidence: 99%

Drain fluid amylase and lipase as a predictive factor of postoperative pancreatic fistula

Koek

Wiegele

Ballal

2021

ANZ Journal of Surgery

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

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

Rykina-Tameeva

MacCulloch

Hipperson

et al. 2023

International Journal of Surgery

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Background: Pancreatectomy is the only curative treatment available for pancreatic cancer and a necessity for patients with challenging pancreatic pathology. To optimize outcomes, postsurgical complications such as clinically relevant postoperative pancreatic fistula (CR-POPF) should be minimized. Central to this is the ability to predict and diagnose CR-POPF, potentially through drain fluid biomarkers. This study aimed to assess the utility of drain fluid biomarkers for predicting CR-POPF by conducting a diagnostic test accuracy systematic review and meta-analysis. Methods: Five databases were searched for relevant and original papers published from January 2000 to December 2021, with citation chaining capturing additional studies. The QUADAS-2 tool was used to assess the risk of bias and concerns regarding applicability of the selected studies. Results: Seventy-eight papers were included in the meta-analysis, encompassing six drain biomarkers and 30 758 patients with a CR-POPF prevalence of 17.42%. The pooled sensitivity and specificity for 15 cut-offs were determined. Potential triage tests (negative predictive value >90%) were identified for the ruling out of CR-POPF and included postoperative day 1 (POD1) drain amylase in pancreatoduodenectomy (PD) patients (300 U/l) and in mixed surgical cohorts (2500 U/l), POD3 drain amylase in PD patients (1000–1010 U/l) and drain lipase in mixed surgery groups (180 U/l). Notably, drain POD3 lipase had a higher sensitivity than POD3 amylase, while POD3 amylase had a higher specificity than POD1. Conclusions: The current findings using the pooled cut-offs will offer options for clinicians seeking to identify patients for quicker recovery. Improving the reporting of future diagnostic test studies will further clarify the diagnostic utility of drain fluid biomarkers, facilitating their inclusion in multivariable risk-stratification models and the improvement of pancreatectomy outcomes.

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“…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.…”

Section: Introductionmentioning

confidence: 99%

“…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).…”

Section: Introductionmentioning

confidence: 99%

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

Rykina-Tameeva¹,

Samra²,

Sahni³

et al. 2022

World J Gastrointest Surg

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Clinically relevant postoperative pancreatic fistula (CR-POPF) has continued to compromise patient recovery post-pancreatectomy despite decades of research seeking to improve risk prediction and diagnosis. The current diagnostic criteria for CR-POPF requires elevated drain fluid amylase to present alongside POPF-related complications including infection, haemorrhage and organ failure. These worrying sequelae necessitate earlier and easily obtainable biomarkers capable of reflecting evolving CR-POPF. Drain fluid has recently emerged as a promising source of biomarkers as it is derived from the pancreas and hence, capable of reflecting its postoperative condition. The present review aims to summarise the current knowledge of CR-POPF drain fluid biomarkers and identify gaps in the field to invigorate future research in this critical area of clinical need. These findings may provide robust diagnostic alternatives for CR-POPF and hence, to clarify their clinical utility require further reports detailing their diagnostic and/or predictive accuracy.

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Comparison of drain fluid lipase with drain fluid amylase in the context of post-operative pancreatic fistula

Cited by 3 publications

References 0 publications

Drain fluid amylase and lipase as a predictive factor of postoperative pancreatic fistula

Drain fluid amylase and lipase as a predictive factor of postoperative pancreatic fistula

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

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

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