Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy: A Multi-institutional Analysis and External Validation

Laura Maggino, Giuseppe Malleo, Claudio Bassi, Valentina Allegrini, Joal D. Beane, Ross M. Beckman, Bofeng Chen, Euan J. Dickson, Jeffrey A. Drebin, Brett L. Ecker, Douglas L. Fraker, Michael House, Nigel B. Jamieson, Ammar A. Javed, Stacy J. Kowalsky, Major K. Lee, Matthew T. McMillan, Robert E. Roses, Roberto Salvia, Vicente ValeroLavanniya K.P. Velu, Christopher L. Wolfgang, Amer H. Zureikat, Charles M. Vollmer

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)337-343
Number of pages7
JournalAnnals of Surgery
Volume269
Issue number2
DOIs
StatePublished - Feb 1 2019
Externally publishedYes

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Pancreatectomy
Amylases
Fistula
Demography
Sensitivity and Specificity
Pancreaticoduodenectomy
Practice Guidelines
Area Under Curve

ASJC Scopus subject areas

  • Surgery

Cite this

Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy : A Multi-institutional Analysis and External Validation. / Maggino, Laura; Malleo, Giuseppe; Bassi, Claudio; Allegrini, Valentina; Beane, Joal D.; Beckman, Ross M.; Chen, Bofeng; Dickson, Euan J.; Drebin, Jeffrey A.; Ecker, Brett L.; Fraker, Douglas L.; House, Michael; Jamieson, Nigel B.; Javed, Ammar A.; Kowalsky, Stacy J.; Lee, Major K.; McMillan, Matthew T.; Roses, Robert E.; Salvia, Roberto; Valero, Vicente; Velu, Lavanniya K.P.; Wolfgang, Christopher L.; Zureikat, Amer H.; Vollmer, Charles M.

In: Annals of Surgery, Vol. 269, No. 2, 01.02.2019, p. 337-343.

Research output: Contribution to journalArticle

Maggino, L, Malleo, G, Bassi, C, Allegrini, V, Beane, JD, Beckman, RM, Chen, B, Dickson, EJ, Drebin, JA, Ecker, BL, Fraker, DL, House, M, Jamieson, NB, Javed, AA, Kowalsky, SJ, Lee, MK, McMillan, MT, Roses, RE, Salvia, R, Valero, V, Velu, LKP, Wolfgang, CL, Zureikat, AH & Vollmer, CM 2019, 'Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy: A Multi-institutional Analysis and External Validation', Annals of Surgery, vol. 269, no. 2, pp. 337-343. https://doi.org/10.1097/SLA.0000000000002532
Maggino, Laura ; Malleo, Giuseppe ; Bassi, Claudio ; Allegrini, Valentina ; Beane, Joal D. ; Beckman, Ross M. ; Chen, Bofeng ; Dickson, Euan J. ; Drebin, Jeffrey A. ; Ecker, Brett L. ; Fraker, Douglas L. ; House, Michael ; Jamieson, Nigel B. ; Javed, Ammar A. ; Kowalsky, Stacy J. ; Lee, Major K. ; McMillan, Matthew T. ; Roses, Robert E. ; Salvia, Roberto ; Valero, Vicente ; Velu, Lavanniya K.P. ; Wolfgang, Christopher L. ; Zureikat, Amer H. ; Vollmer, Charles M. / Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy : A Multi-institutional Analysis and External Validation. In: Annals of Surgery. 2019 ; Vol. 269, No. 2. pp. 337-343.
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title = "Identification of an Optimal Cut-off for Drain Fluid Amylase on Postoperative Day 1 for Predicting Clinically Relevant Fistula After Distal Pancreatectomy: A Multi-institutional Analysis and External Validation",
abstract = "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.",
author = "Laura Maggino and Giuseppe Malleo and Claudio Bassi and Valentina Allegrini and Beane, {Joal D.} and Beckman, {Ross M.} and Bofeng Chen and Dickson, {Euan J.} and Drebin, {Jeffrey A.} and Ecker, {Brett L.} and Fraker, {Douglas L.} and Michael House and Jamieson, {Nigel B.} and Javed, {Ammar A.} and Kowalsky, {Stacy J.} and Lee, {Major K.} and McMillan, {Matthew T.} and Roses, {Robert E.} and Roberto Salvia and Vicente Valero and Velu, {Lavanniya K.P.} and Wolfgang, {Christopher L.} and Zureikat, {Amer H.} and Vollmer, {Charles M.}",
year = "2019",
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doi = "10.1097/SLA.0000000000002532",
language = "English (US)",
volume = "269",
pages = "337--343",
journal = "Annals of Surgery",
issn = "0003-4932",
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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

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.

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