Drain fluid biomarkers for prediction and diagnosis of clinically relevant postoperative pancreatic fistula: A narrative review

Table 3 Recommendations for future research

Drain biomarker	To investigate	To confirm
Amylase	Accuracy of intraoperative predictive cut-offs in pancreatoduodenectomy patients	Diagnostic accuracy of proposed cut-offs
	Accuracy of POD2 cut-offs in distal pancreatectomy patients	The change in postoperative drain amylase required to be predictive of CR-POPF in pancreatoduodenectomy patients
	Accuracy of POD4 cut-offs in surgery specific cohorts	If a persistently high value for drain amylase x drain volume postoperatively is predictive of CR-POPF
	Accuracy of risk-stratified cut-offs in distal pancreatectomy patients
	The change in postoperative drain amylase required to be predictive of CR-POPF in distal pancreatectomy patients
	When drain amylase has the highest predictive accuracy
Lipase	The change in postoperative drain lipase required to be predictive of CR-POPF in surgery specific cohorts and its accuracy	Diagnostic accuracy of proposed cut-offs
	The accuracy of predictive cut-offs before POD3 in surgery specific cohorts	Diagnostic value of drain lipase in multi-factorial predictive models
	Accuracy of risk-stratified cut-offs in surgery specific cohorts	When drain amylase has the highest predictive accuracy
Drain culture	Bacteria within polymicrobial drain fluid samples which predict grade B and C POPF in surgery specific cohorts	Clinical relevance of Enterobacter, Enterococcus and Staphylococcus to CR-POPF risk in pancreatoduodenectomy patients
	When particular microorganisms are most predictive of CR-POPF
	The concentrations of high-risk bacteria that accurately predict CR-POPF in surgery specific cohorts
Other biomolecules	Accuracy of predictive cut-offs for each biomarker in surgery specific cohorts
	Accuracy of novel enzymes compared to drain amylase and lipase in matched surgical cohorts and PODs
Fluid appearance	Accuracy on specific days before POD3

POD: Postoperative day; CR-POPF: Clinically relevant postoperative pancreatic fistula.