title: The gastric/pancreatic amylase ratio predicts postoperative pancreatic fistula with high sensitivity and specificity.
abstract: This article aims to identify risk factors for postoperative pancreatic fistula (POPF) and evaluate the gastric/pancreatic amylase ratio (GPAR) on postoperative day (POD) 3 as a POPF predictor in patients who undergo pancreaticoduodenectomy (PD).POPF significantly contributes to mortality and morbidity in patients who undergo PD. Previously identified predictors for POPF often have low predictive accuracy. Therefore, accurate POPF predictors are needed.In this prospective cohort study, we measured the clinical and biochemical factors of 61 patients who underwent PD and diagnosed POPF according to the definition of the International Study Group of Pancreatic Fistula. We analyzed the association between POPF and various factors, identified POPF risk factors, and evaluated the predictive power of the GPAR on POD3 and the levels of serum and ascites amylase.Of the 61 patients, 21 developed POPF. The color of the pancreatic drain fluid, POD1 serum, POD1 median output of pancreatic drain fluid volume, and GPAR were significantly associated with POPF. The color of the pancreatic drain fluid and high GPAR were independent risk factors. Although serum and ascites amylase did not predict POPF accurately, the cutoff value was 1.24, and GPAR predicted POPF with high sensitivity and specificity.This is the first report demonstrating that high GPAR on POD3 is a risk factor for POPF and showing that GPAR is a more accurate predictor of POPF than the previously reported amylase markers.
authors.affiliation: From the Department of Hepatobiliary and Pancreatic Surgery (SJ, X-JS, X-DS, PZ, G-YL, X-HD, G-YW), Bethune First Hospital of Jilin University, Changchun 130021, Jilin; and Department of Surgery Intensive Care Unit (S-YW), Beijing Chao-yang Hospital Affiliated to Capital Medical University, Beijing, China.
authors.forename: Shuo
authors.initials: S
authors.lastname: Jin
authors.forename: Xiao-Ju
authors.initials: XJ
authors.lastname: Shi
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Sun
authors.forename: Ping
authors.initials: P
authors.lastname: Zhang
authors.forename: Guo-Yue
authors.initials: GY
authors.lastname: Lv
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Du
authors.forename: Si-Yuan
authors.initials: SY
authors.lastname: Wang
authors.forename: Guang-Yi
authors.initials: GY
authors.lastname: Wang
mesh_terms: D000681:Amylases / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000201:enzymology*; D010185:Pancreatic Fistula / Q000453:epidemiology*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications / Q000453:epidemiology*; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013270:Stomach / Q000201:enzymology*; D013997:Time Factors
chemical_list: D015415:Biomarkers; D000681:Amylases