title: Negative predictive value of drain amylase concentration for development of pancreatic fistula after pancreaticoduodenectomy.
abstract: BACKGROUND
  Post-operative pancreatic fistula (POPF) is the major source of morbidity following pancreaticoduodenectomy. A predictive indicator would be highly advantageous. One potential marker is drain amylase concentration (DAC). However, its predictive value has not been fully established.
  
  
  METHODS
  405 patients undergoing pancreaticoduodenectomy at our centre over a 10 year period were reviewed to determine the value of DAC as a predictive indicator for the development of POPF.
  
  
  RESULTS
  POPF developed in 58 patients (14%). These patients suffered greater morbidity. Overall 30-day mortality was 1.5%. Male gender (OR: 5.1; p = 0.0082) and age > 70 (OR 2; p = 0.0372) were independent risk factors for POPF, whilst Type 2 diabetes (OR: 0.2321; p = 0.0090) and pancreatic ductal-adenocarcinoma (OR: 0.3721; p = 0.0039) decreased POPF risk. The DACs post-operatively were significantly higher in those developing POPF, but with significant overlap. ROC curves revealed optimal threshold values for differentiating POPF and non-POPF patients. A DAC°<°1400 U/ml on day 1 and <768 U/ml on day 2, although having a poor positive predictive value (32-44%), had a very strong negative predictive value (97-99%).
  
  
  CONCLUSIONS
  Our data suggest that post-operative DAC below the determined optimal threshold values on day 1 and 2 following pancreaticoduodenectomy carries high negative predictive value for POPF development and identifies patients in whom early drain removal, and enhanced recovery may be considered, with simultaneous assessment of operative and clinical factors.
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Piotr
authors.initials: P
authors.lastname: Zelga
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK. Electronic address: ja297@cam.ac.uk.
authors.forename: Jason M
authors.initials: JM
authors.lastname: Ali
authors.affiliation: Department of Histopathology, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Brais
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Simon J F
authors.initials: SJ
authors.lastname: Harper
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Siong-Seng
authors.initials: SS
authors.lastname: Liau
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Emmanuel L
authors.initials: EL
authors.lastname: Huguet
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Neville V
authors.initials: NV
authors.lastname: Jamieson
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Raaj K
authors.initials: RK
authors.lastname: Praseedom
authors.affiliation: HPB & Transplant Surgery Unit, Cambridge University Hospitals NHS Trust, Cambridge, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000032:analysis*; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000601:surgery; D004322:Drainage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010185:Pancreatic Fistula / Q000201:enzymology* / Q000453:epidemiology / Q000209:etiology*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects*; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D011237:Predictive Value of Tests; D012307:Risk Factors; D012737:Sex Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000681:Amylases
keywords: Drain amylase concentration; Drain removal; Enhanced recover; Pancreaticoduodenectomy; Postoperative pancreatic fistula; Whipples resection