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

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.