Lu Xiongxiong, Wang Xinjing, Fang Yuan, Chen Hao, Peng Chenghong, Li Hongwei, Deng Xiaxing, Shen Baiyong
From the Pancreatic Disease Center; Research Institute of Pancreatic Disease; Shanghai Institute of Digestive Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Medicine (Baltimore). 2016 Feb;95(5):e2569. doi: 10.1097/MD.0000000000002569.
Early detection of postoperative pancreatic fistula (POPF) may help to improve the outcome following pancreatic surgery, and exclusion of POPF may allow early drain removal which can accelerate recovery. The aim of this study was to evaluate the diagnostic accuracy of drain/plasma pancreatic amylase values on postoperative day 1 (DPA1/PPA1) in POPF by means of a systemic review and meta-analysis.Online journal databases and a manual search up to March 2015 were used. Studies clearly documenting DPA1 or PPA1 in predicting overall POPF (Grade 0 vs A+B+C) or clinically relevant POPF (Grade 0+A vs B+C) following pancreatic surgery were selected. Pooled predictive parameters were performed using STATA 12.0.Fifteen studies were finally identified with a total of 4331 patients. The pooled sensitivity and specificity of DPA1 were 0.92 (95% confidence interval (CI) 0.81-0.96) and 0.77 (95% CI 0.64-0.86) for predicting overall POPF and 0.79 (95% CI 0.61-0.90) and 0.83 (95% CI 0.74-0.89) for predicting clinically relevant POPF. The pooled sensitivity and specificity of PPA1 were 0.74 (95% CI 0.63-0.82) and 0.62 (95% CI 0.55-0.70) for overall POPF. After the DPA1 at/over cutoff values for overall POPF or clinically relevant POPF, corresponding post-test probability (Post-test (+)) (if pretest probability was 50%) was 80% and 82% respectively, while, if values were below the cutoff values, the post-test probability (Post-test (-)) was 10% and 20% respectively. Post-test (+) and Post-test (-) of PPA1 for overall POPF were 66% and 30% respectively. In subgroup analysis, the summary sensitivities of cutoff <1000 group and cutoff >1000 group were 0.96 (0.92-0.98) and 0.85 (0.64-0.95), respectively; the summary specificities were 0.59 (0.44-0.72) and 0.86 (0.80-0.91) respectively. Positive LR were 2.3 (1.7-3.3) and 6.2 (3.7-10.2) respectively. Negative LR were 0.06 (0.03-0.14) and 0.18 (0.07-0.47) respectively.DPA1 is a useful predictive test for overall POPF and clinically relevant POPF which has good sensitivity and specificity based on the current studies. Meanwhile, it should be cautiously applied to clinical practice because cutoffs had a wide range between studies.
早期发现术后胰瘘（POPF）可能有助于改善胰腺手术后的预后，排除POPF则可早期拔除引流管，从而加速康复。本研究旨在通过系统评价和荟萃分析评估术后第1天（DPA1）引流液/血浆胰淀粉酶值（PPA1）对POPF的诊断准确性。使用了在线期刊数据库并进行了截至2015年3月的手工检索。选择了明确记录DPA1或PPA1用于预测胰腺手术后总体POPF（0级 vs A + B + C级）或临床相关POPF（0 + A级 vs B + C级）的研究。使用STATA 12.0进行合并预测参数分析。最终确定了15项研究，共4331例患者。DPA1预测总体POPF的合并敏感性和特异性分别为0.92（95%置信区间（CI）0.81 - 0.96）和0.77（95%CI 0.64 - 0.86），预测临床相关POPF的合并敏感性和特异性分别为0.79（95%CI 0.61 - 0.90）和0.83（95%CI 0.74 - 0.89）。PPA1预测总体POPF的合并敏感性和特异性分别为0.74（95%CI 0.63 - 0.82）和0.62（95%CI 0.55 - 0.70）。总体POPF或临床相关POPF的DPA1达到/超过临界值后，相应的验后概率（验后（+））（如果验前概率为50%）分别为80%和82%，而如果值低于临界值，验后概率（验后（-））分别为10%和20%。PPA1对总体POPF的验后（+）和验后（-）分别为66%和30%。在亚组分析中，临界值<1000组和临界值>1000组的汇总敏感性分别为0.96（0.92 - 0.98）和0.85（0.64 - 0.95）；汇总特异性分别为0.59（0.44 - 0.72）和0.86（0.80 - 0.91）。阳性似然比分别为2.3（1.7 - 3.3）和6.2（3.7 - 10.2）。阴性似然比分别为0.06（0.03 - 0.14）和0.18（0.07 - 0.47）。基于目前的研究，DPA1是预测总体POPF和临床相关POPF的有用检测方法，具有良好的敏感性和特异性。同时，由于各研究之间临界值范围较宽，应谨慎应用于临床实践。
