Annals of Surgery Open (Sep 2024)

Diagnostic Accuracy of Lipase as Early Predictor of Postoperative Pancreatic Fistula: Results from the LIPADRAIN study

  • Béranger Doussot, MD,
  • Alexandre Doussot, MD, PhD,
  • Ahmet Ayav, MD, PhD,
  • Nicolas Santucci, MD,
  • Sophie Deguelte, MD,
  • Amadou Khalilou Sow, MD,
  • Mehdi El Amrani, MD, PhD,
  • Laurence Duvillard, MD, PhD,
  • Guillaume Piessen, MD, PhD,
  • Edouard Girard, MD, PhD,
  • Jean-Yves Mabrut, MD, PhD,
  • Jonathan Garnier, MD, PhD,
  • Pablo Ortega-Deballon, MD, PhD,
  • Isabelle Fournel, MD, PhD,
  • Olivier Facy, MD, PhD

DOI
https://doi.org/10.1097/AS9.0000000000000492
Journal volume & issue
Vol. 5, no. 3
p. e492

Abstract

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Objective:. To evaluate the diagnostic accuracy of drain fluid lipase as an early predictor of postoperative pancreatic fistula and establish the most appropriate day for their measure. Background:. Clinically relevant postoperative pancreatic fistula remains a potentially life-threatening complication after pancreatic surgery. Early detection strategies remain key to reduce both the incidence and the burden of pancreatic fistula. Methods:. The LIPAse DRAIN (LIPADRAIN) study is a multicenter, prospective diagnostic study conducted in 7 tertiary university hospitals. Drain fluid values to detect clinically relevant postoperative pancreatic fistula from postoperative day 1 to postoperative day 6 were evaluated using receiver operating characteristic curve analysis. A biomarker was considered to be relevant for clinical use if its area under the curve (AUC) was greater than 0.75. Results:. Of the 625 patients included in the analysis, clinically relevant postoperative pancreatic fistula occurred in 203 (32%) patients. On postoperative days 3 and 4, drain fluid lipase was a reliable biomarker to detect clinically relevant postoperative pancreatic fistula (AUC: 0.761; 95% confidence interval [CI]: 0.761–0.799 and AUC: 0.784; 95% CI: 0.743–0.821, respectively). On postoperative day 3, with a threshold of 299 units/L, drain fluid lipase yielded a negative predictive value of 51%, sensitivity of 78%, and specificity of 63% for the detection of clinically relevant postoperative pancreatic fistula. Conclusions:. In this multicenter prospective study, drain fluid lipase is a reliable biomarker at postoperative days 3 and 4 for the diagnosis of clinically relevant postoperative pancreatic fistula after pancreatic surgery and should be systematically measured on postoperative day 3.