Combined inflammatory markers and amylase levels for early detection of postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy

Abstract

BACKGROUND

Clinically relevant postoperative pancreatic fistula (CR-POPF) is a major complication after laparoscopic pancreaticoduodenectomy (LPD), increasing the risks of bleeding, infection, prolonged hospitalization, and mortality. Early risk stratification remains challenging. Postoperative amylase indices and inflammatory markers may capture pancreatic leakage and systemic inflammatory response, respectively, and their combination may improve early prediction.

AIM

To evaluate the predictive value of combined inflammatory markers and amylase levels for the early detection of CR-POPF following LPD.

METHODS

This retrospective study analyzed 67 patients undergoing LPD between January 2019 and January 2023, and 31 patients developed CR-POPF. The amylase levels of drainage fluid and serum [drain fluid amylase concentration (DAC) and serum amylase concentration (SAC)] were measured on postoperative day (POD) 1 and POD3, and the drain-to-serum amylase concentration ratio (DSACR) was calculated on POD1 and POD3. Plasma interleukin-6 (IL-6), IL-8, and C-reactive protein (CRP) were also measured. Diagnostic performance was assessed using receiver operating characteristic curves, and areas under the receiver operating characteristic curves were compared using the DeLong test; multivariable logistic models were used to evaluate combined prediction.

RESULTS

Patients with CR-POPF exhibited higher SAC levels on POD1, alongside increased DAC, DSACR, and plasma IL-6, IL-8, and CRP levels on both POD1 and POD3. On POD1, DAC, SAC, and DSACR demonstrated sensitivities of 83.87%, 77.42%, and 70.97%, with specificities of 83.33%, 52.78%, and 63.89%, respectively. Plasma CRP, IL-8, and IL-6 presented sensitivities of 41.94%, 70.97%, and 64.52%, and specificities of 88.89%, 83.33%, and 88.89%, respectively. On POD3, DAC, SAC, and DSACR showed sensitivities of 93.55%, 93.55%, and 96.77%, with specificities of 61.11%, 33.33%, and 83.33%, respectively. Plasma CRP, IL-8, and IL-6 exhibited POD3 sensitivities of 70.97%, 77.42%, and 80.65%, and specificities of 80.56%, 86.11%, and 86.11%. The combination of CRP, IL-8, and IL-6 plasma levels with DAC, SAC, and DSACR demonstrated robust predictive abilities for CR-POPF prognosis on both POD1 and POD3.

CONCLUSION

This study highlights the predictive value of combined inflammatory markers and amylase levels in early CR-POPF detection after LPD, suggesting the clinical utility of these biomarkers in pancreatic surgery.

Keywords: Laparoscopic pancreaticoduodenectomy; Pancreatic fistula; Inflammatory markers; Amylase; Diagnostic accuracy

Core Tip: Clinically relevant postoperative pancreatic fistula remains a major driver of morbidity after laparoscopic pancreaticoduodenectomy. A combined model incorporating amylase indices (drain fluid amylase concentration, serum amylase concentration, drain-to-serum amylase concentration ratio) and inflammatory markers (interleukin-6/interleukin-8/C-reactive protein) showed high areas under the receiver operating characteristic curves on postoperative day 1 and postoperative day 3, supporting early identification of high-risk patients.