Preoperative systemic inflammatory biomarkers and postoperative day 1 drain amylase value predict grade C pancreatic fistula after pancreaticoduodenectomy

Background: Postoperative day 1-drains amylase (POD1-DA) values are commonly used to predict the risk ofpancreatic fistula (PF) after pancreaticoduodenectomy (PD). Perioperative inflammatory biomarkers have beenassociated to higher risk of complications in different oncological surgeries. Aim of this study was to investigatethe utility of the combination of preoperative inflammatory biomarkers (PIBs) with POD1-DA levels in predictinggrade C PF.Materials and methods: From a prospective collected database of 317 consecutive pancreaticoduodenectomies,data regarding POD1-DA levels and PIBs as neutrophil-to-lymphocyte ratio (NRL), derived neutrophil-to-lymphocyteratio (dNRL), platelet-to-lymphocyte ratio (PLR) were analyzed in 227 cases. P-values<0.05 wereconsidered statistically significant. Receiver operating characteristic (ROC) curves defined the optimal thresholdsfor biomarkers and drains amylase values and their accuracy to predict PF. Furthermore, the PositivePredictive Value (PPV) was computed to evaluate the probability to develop PF combining PIBs and drainsamylase values. Combination of drains amylase and different PIBs cut-offs were used to evaluate the risk of gradeC PF.Results: A POD1-DA level of 351 U/L significantly predicted PF (sensitivity 82.7%, specificity 76%, AUC 0.836;p < 0.001) with a PPV of 76.5% and a NPV of 82.6%.POD1-DA levels ≥807 U/L significantly predicted grade C PF (sensitivity 72.7%, specificity 64.4%, AUC0.676; p = 0.004) with a PPV of 17.8% and a NPV of 95.6%.Notably, this last PPV increased from 17.8% to 89% when PIBs, at different cut-offs, were combined withPOD1-DA at the value ≥ 807 U/L.Conclusion: PIBs significantly improve POD1-DA ability in predicting grade C PF after PD.