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

Table 1 Baseline characteristics in no clinically relevant postoperative pancreatic fistula and clinically relevant postoperative pancreatic fistula groups following laparoscopic pancreaticoduodenectomy, mean ± SD/median (interquartile range)

Parameter	No CR-POPF (n = 36)	CR-POPF (n = 31)	P value
Gender			0.142
Male	19	22
Female	17	9
Age (years)	66 (58, 70.75)	64 (56, 74)	0.988
Body mass index (kg/cm2)	19.78 ± 3.25	18.65 ± 3.04	0.165
Pathological type			0.333
Pancreatic cancer	15	6
Bile duct cancer	9	11
Ampullary cancer	6	5
Duodenal malignancy	4	5
Other	2	4
Operation time (minutes)	360 (322.5, 415)	348 (300, 460)	0.933
Intraoperative bleeding (mL)	145 (100, 500)	170 (145, 280)	0.42
Intraoperative transfusion			0.089
Yes	12	17
No	24	14
Hospital stays (days)	24 (20, 30.25)	35 (27, 42)	0.001
Drain fluid amylase concentration (U/L)
POD1	2304 (1195, 3496)	7177 (4386, 11581)	< 0.001
POD3	415.5 (222.3, 3311)	1860 (1370, 2888)	0.037
Serum amylase concentration (U/L)
POD1	81.83 (23.4, 199.9)	156 (89.65, 307.8)	0.049
POD3	39.05 (25.29, 360.4)	53.21 (17.42, 86.53)	0.522
Drain-to-serum amylase concentration ratio
POD1	22.05 (10.4, 48.65)	37 (23, 48)	0.022
POD3	9.55 (5.625, 13.18)	42 (25, 80)	< 0.001

CR-POPF: Clinically relevant postoperative pancreatic fistula; POD: Postoperative day.

Table 2 Diagnostic accuracy of biomarkers for clinically relevant postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy on postoperative day 1

ROC curve analysis	Drain fluid amylase concentration (U/L)	Serum amylase concentration (U/L)	Drain-to-serum amylase concentration ratio	C-reactive protein (pg/mL)	IL-8 (pg/mL)	IL-6 (pg/mL)
Areas under the ROC curve	0.866	0.641	0.662	0.658	0.708	0.812
95%CI	0.760-0.937	0.514-0.754	0.536-0.773	0.532-0.769	0.584-0.813	0.698-0.897
P value	< 0.001	0.041	0.017	0.019	0.003	< 0.001
Youden index J	0.672	0.302	0.3486	0.308	0.543	0.534
Associated criterion	> 3767	> 82.68	> 24.9	> 135.1	> 88.09	> 244.91
Sensitivity	83.87	77.42	70.97	41.94	70.97	64.52
Specificity	83.33	52.78	63.89	88.89	83.33	88.89

IL: Interleukin; ROC: Receiver operating characteristic.

Table 3 Diagnostic accuracy of biomarkers for clinically relevant postoperative pancreatic fistula following laparoscopic pancreaticoduodenectomy on postoperative day 3

ROC curve analysis	Serum amylase concentration (U/L)	Drain fluid amylase concentration (U/L)	Drain-to-serum amylase concentration ratio	C-reactive protein (pg/mL)	IL-8 (pg/mL)	IL-6 (pg/mL)
Areas under the ROC curve	0.648	0.546	0.865	0.790	0.875	0.893
95%CI	0.522-0.761	0.420-0.668	0.760-0.936	0.674-0.880	0.772-0.943	0.794-0.956
P value	0.043	0.525	< 0.001	< 0.001	< 0.001	< 0.001
Youden index J	0.5466	0.2688	0.8011	0.515	0.635	0.668
Associated criterion	> 734	≤ 168.36	> 14	> 336.19	> 78.23	> 177.9
Sensitivity	93.55	93.55	96.77	70.97	77.42	80.65
Specificity	61.11	33.33	83.33	80.56	86.11	86.11

IL: Interleukin; ROC: Receiver operating characteristic.

Table 4 Pairwise receiver operating characteristic curve comparison of biomarkers for clinically relevant postoperative pancreatic fistula detection

Pairwise comparison of receiver operating characteristic curves		POD1	POD3
CRP vs DAC	Difference between areas	0.208	0.142
	P value	0.017	0.118
CRP vs DSACR	Difference between areas	0.004	0.075
	P value	0.961	0.342
CRP vs IL-6	Difference between areas	0.154	0.103
	P value	0.086	0.100
CRP vs IL-8	Difference between areas	0.050	0.085
	P value	0.627	0.173
CRP vs SAC	Difference between areas	0.017	0.244
	P value	0.864	0.008
DAC vs DSACR	Difference between areas	0.203	0.217
	P value	0.007	0.009
DAC vs IL-6	Difference between areas	0.054	0.245
	P value	0.441	0.005
DAC vs IL-8	Difference between areas	0.158	0.227
	P value	0.079	0.006
DAC vs SAC	Difference between areas	0.225	0.102
	P value	0.001	0.443
DSACR vs IL-6	Difference between areas	0.150	0.028
	P value	0.123	0.671
DSACR vs IL-8	Difference between areas	0.046	0.010
	P value	0.662	0.881
DSACR vs SAC	Difference between areas	0.022	0.319
	P value	0.8625	< 0.001
IL-6 vs IL-8	Difference between areas	0.104	0.018
	P value	0.239	0.744
IL-6 vs SAC	Difference between areas	0.171	0.347
	P value	0.025	< 0.001
IL-8 vs SAC	Difference between areas	0.067	0.329
	P value	0.477	< 0.001

CRP: C-reactive protein; DAC: Drain fluid amylase concentration; DSACR: Drain-to-serum amylase concentration ratio; IL: Interleukin; POD: Postoperative day; SAC: Serum amylase concentration.