Purpose: To date, no study has correlated biochemical analysis of pancreatic fluid collection (PFC) contents with clinical and radiological characteristics. This study aimed to assess the predictive value of fluid analysis for discerning collection type (pseudocyst vs. pancreatic necrosis), presence of infection or communication with the pancreatic duct (PD).
Methods: Pancreatic fluid from 34 consecutive patients undergoing endotherapy of PFCs was prospectively analyzed for seven variables: lactate dehydrogenase (LDH), total protein, albumin, glucose, amylase, lipase and specific gravity.
Results: Pseudocysts were present in 19 patients and pancreatic necrosis in 15; 12 patients had infection of the fluid collection, pancreatogram demonstrated PD communication in 17. In multivariate analysis, high intra-cystic levels of protein (OR, 6.2, 95% C.I., 1.3, 37.0), LDH (OR, 6.8 [2.3, 38.3]), albumin (OR, 7.8 [1.3, 67.4]) and low levels of glucose (OR, 0.2 [0.03, 0.9]) predicted PFC infection. The optimal threshold for protein was 1,000 g/dL, which achieved a sensitivity of 73% and specificity of 75% for detecting infection; optimal cut-off for LDH was 1,000 U/L (sensitivity 64%, specificity 85%), cut-off for albumin was 500 g/dL (sensitivity 75%, specificity 85%) (see figures). There were no statistically significant differences in biochemical fluid analysis with respect to fluid collection type (pseudocysts vs. necrosis) or PD communication.
Conclusions: Biochemical analysis of PFC fluid is clinically helpful in detecting infection. Our findings fail to support the utility of fluid analysis in distinguishing pseudocysts from pancreatic necrosis. [figure 1] [figure 2]