Predictive value of postoperative serum lipase level for postoperative pancreatic fistula after pancreaticoduodenectomy

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International Pub Date : 2025-01-31 DOI:10.1016/j.hbpd.2025.01.002

Bing-Jun Tang , Si-Jia Li , Peng-Fei Wang , Can-Hong Xiang , Jian-Ping Zeng , Jun Shi , Jia-Hong Dong , Xue-Dong Wang

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引用次数: 0

Abstract

Background

The prediction of postoperative pancreatic fistula (POPF) is important. This study aimed to investigate the role of postoperative serum lipase level in predicting POPF.

Methods

Data from 234 consecutive patients who underwent pancreaticoduodenectomy (PD) were collected. The predictive values of serum amylase and serum lipase during postoperative days (PODs) 1 to 3 for POPF were compared. Subgroup analyses were performed to determine the prognostic value of different levels and durations of elevated serum lipase.

Results

Fifty-six patients developed POPF. The POPF group exhibited increased levels of serum amylase and lipase from PODs 1 to 3 (all P < 0.001). Compared with serum amylase, serum lipase has greater predictive value for POPF. Specifically, serum lipase had the highest area under the receiver operating characteristic curve (AUC) at POD 1 (0.791). Body mass index > 24 kg/m² [odds ratio (OR) = 2.431, 95% confidence interval (CI): 1.094–5.404, P = 0.029], soft pancreatic texture (OR = 3.189, 95% CI: 1.263–8.056, P = 0.014), serum lipase > 60 U/L at POD 1 (OR = 5.135, 95% CI: 1.257–20.982, P = 0.023), and C-reactive protein > 167 mg/dL at POD 3 (OR = 3.607, 95% CI: 1.431–9.090, P = 0.007) were identified as independent risk factors for POPF. Patients with serum lipase ≤ 60 U/L at POD 1 (n = 104) exhibited lower rates of POPF (3.8% vs. 40.0%, P < 0.001) and severe complications (Clavien-Dindo ≥ IIIa) (4.8% vs. 25.4%, P < 0.001) than those with serum lipase > 60 U/L at POD 1. Moreover, no additional elevation or duration of serum lipase offered any further prognostic value.

Conclusions

Postoperative serum lipase outperformed serum amylase in the prediction of POPF, and patients with normal serum lipase level at POD 1 had favorable outcomes. A sustained increase in the serum lipase level offers no additional prognostic value.

查看原文本刊更多论文

胰十二指肠切除术后血清脂肪酶水平对胰瘘的预测价值。

背景：预测术后胰瘘（POPF）的发生具有重要意义。本研究旨在探讨术后血清脂肪酶水平在预测POPF中的作用。方法：收集234例连续行胰十二指肠切除术（PD）患者的资料。比较术后1 ~ 3天血清淀粉酶和脂肪酶对POPF的预测价值。进行亚组分析，以确定不同水平和持续时间的血清脂肪酶升高的预后价值。结果：56例发生POPF。从pod 1到pod 3， POPF组血清淀粉酶和脂肪酶水平升高（均P < 0.001）。与血清淀粉酶相比，血清脂肪酶对POPF有更大的预测价值。其中，血清脂肪酶在POD为1时的受试者工作特征曲线下面积（AUC）最高（0.791）。体重指数>4 kg/m2[比值比(OR) = 2.431, 95 %置信区间（CI）： 1.094-5.404, P = 0.029]、胰腺质地软（OR = 3.189, 95 % CI: 1.263-8.056, P = 0.014）、血清脂肪酶>在POD 1时60 U/L （OR = 5.135, 95 % CI: 1.257-20.982, P = 0.023）、c反应蛋白>在POD 3时167 mg/dL （OR = 3.607, 95 % CI: 1.431-9.090, P = 0.007）被确定为POPF的独立危险因素。在POD 1时，血清脂肪酶≤60 U/L的患者（n = 104）的POPF发生率（3.8 %比40.0 %,P < 0.001）和严重并发症（Clavien-Dindo≥IIIa）（4.8 %比25.4 %,P < 0.001）低于POD 1时血清脂肪酶为60 U/L的患者。此外，血清脂肪酶的升高或持续时间没有提供任何进一步的预后价值。结论：术后血清脂肪酶在预测POPF方面优于血清淀粉酶，POD 1时血清脂肪酶水平正常的患者预后良好。血清脂肪酶水平的持续升高没有额外的预后价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hepatobiliary & Pancreatic Diseases International 医学-胃肠肝病学

CiteScore

5.40

自引率

6.10%

发文量

152

审稿时长

3.0 months

期刊介绍： Hepatobiliary & Pancreatic Diseases International (HBPD INT) (ISSN 1499-3872 / CN 33-1391/R) a bimonthly journal published by First Affiliated Hospital, Zhejiang University School of Medicine, China. It publishes peer-reviewed original papers, reviews and editorials concerned with clinical practice and research in the fields of hepatobiliary and pancreatic diseases. Papers cover the medical, surgical, radiological, pathological, biochemical, physiological and historical aspects of the subject areas under the headings Liver, Biliary, Pancreas, Transplantation, Research, Special Reports, Editorials, Review Articles, Brief Communications, Clinical Summary, Clinical Images and Case Reports. It also deals with the basic sciences and experimental work. The journal is abstracted and indexed in SCI-E, IM/MEDLINE, EMBASE/EM, CA, Scopus, ScienceDirect, etc.