TY - JOUR
T1 - Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy
T2 - A Multi-institutional Analysis and External Validation
AU - Maggino, Laura
AU - Malleo, Giuseppe
AU - Bassi, Claudio
AU - Allegrini, Valentina
AU - Beane, Joal D.
AU - Beckman, Ross M.
AU - Chen, Bofeng
AU - Dickson, Euan J.
AU - Drebin, Jeffrey A.
AU - Ecker, Brett L.
AU - Fraker, Douglas L.
AU - House, Michael G.
AU - Jamieson, Nigel B.
AU - Javed, Ammar A.
AU - Kowalsky, Stacy J.
AU - Lee, Major K.
AU - McMillan, Matthew T.
AU - Roses, Robert E.
AU - Salvia, Roberto
AU - Valero, Vicente
AU - Velu, Lavanniya K.P.
AU - Wolfgang, Christopher L.
AU - Zureikat, Amer H.
AU - Vollmer, Charles M.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - OBJECTIVE: The aim of this study was to investigate the relationship between drain fluid amylase value on the first postoperative day (DFA1) and clinically relevant fistula (CR-POPF) after distal pancreatectomy (DP), and to identify the cut-off of DFA1 that optimizes CR-POPF prediction. BACKGROUND: DFA1 is a well-recognized predictor of CR-POPF after pancreatoduodenectomy, but its role in DP is largely unexplored. METHODS: DFA1 levels were correlated with CR-POPF in 2 independent multi-institutional sets of DP patients: developmental (n = 338; years 2012 to 2017) and validation cohort (n = 166; years 2006 to 2016). Cut-off choice was based on Youden index calculation, and its ability to predict CR-POPF occurrence was tested in a multivariable regression model adjusted for clinical, demographic, operative, and pathological variables. RESULTS: In the developmental set, median DFA1 was 1745 U/L and the CR-POPF rate was 21.9%. DFA1 correlated with CR-POPF with an area under the curve of 0.737 (P < 0.001). A DFA1 of 2000 U/L had the highest Youden index, with 74.3% sensitivity and 62.1% specificity. Patients in the validation cohort displayed different demographic and operative characteristics, lower values of DFA1 (784.5 U/L, P < 0.001), and reduced CR-POPF rate (10.2%, P < 0.001). However, a DFA1 of 2000 U/L had the highest Youden index in this cohort as well, with 64.7% sensitivity and 75.8% specificity. At multivariable analysis, DFA1 ≥2000 U/L was the only factor significantly associated with CR-POPF in both cohorts. CONCLUSION: A DFA1 of 2000 U/L optimizes CR-POPF prediction after DP. These results provide the substrate to define best practices and improve outcomes for patients receiving DP.
AB - OBJECTIVE: The aim of this study was to investigate the relationship between drain fluid amylase value on the first postoperative day (DFA1) and clinically relevant fistula (CR-POPF) after distal pancreatectomy (DP), and to identify the cut-off of DFA1 that optimizes CR-POPF prediction. BACKGROUND: DFA1 is a well-recognized predictor of CR-POPF after pancreatoduodenectomy, but its role in DP is largely unexplored. METHODS: DFA1 levels were correlated with CR-POPF in 2 independent multi-institutional sets of DP patients: developmental (n = 338; years 2012 to 2017) and validation cohort (n = 166; years 2006 to 2016). Cut-off choice was based on Youden index calculation, and its ability to predict CR-POPF occurrence was tested in a multivariable regression model adjusted for clinical, demographic, operative, and pathological variables. RESULTS: In the developmental set, median DFA1 was 1745 U/L and the CR-POPF rate was 21.9%. DFA1 correlated with CR-POPF with an area under the curve of 0.737 (P < 0.001). A DFA1 of 2000 U/L had the highest Youden index, with 74.3% sensitivity and 62.1% specificity. Patients in the validation cohort displayed different demographic and operative characteristics, lower values of DFA1 (784.5 U/L, P < 0.001), and reduced CR-POPF rate (10.2%, P < 0.001). However, a DFA1 of 2000 U/L had the highest Youden index in this cohort as well, with 64.7% sensitivity and 75.8% specificity. At multivariable analysis, DFA1 ≥2000 U/L was the only factor significantly associated with CR-POPF in both cohorts. CONCLUSION: A DFA1 of 2000 U/L optimizes CR-POPF prediction after DP. These results provide the substrate to define best practices and improve outcomes for patients receiving DP.
UR - http://www.scopus.com/inward/record.url?scp=85059500492&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85059500492&partnerID=8YFLogxK
U2 - 10.1097/SLA.0000000000002532
DO - 10.1097/SLA.0000000000002532
M3 - Article
C2 - 28938266
AN - SCOPUS:85059500492
SN - 0003-4932
VL - 269
SP - 337
EP - 343
JO - Annals of surgery
JF - Annals of surgery
IS - 2
ER -