The Causes and Outcome of Acute Pancreatitis Associated with Serum Lipase >10,000 U/L
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Our objective was to investigate the use of serum lipase levels >10,000 U/L as a tool for predicting the etiology of acute pancreatitis (AP) and to further address the relationship between lipase elevation and disease severity.
We compared patients with AP and serum lipase >10,000 U/L (HL) with patients with AP and lower serum lipase levels (855–10,000 U/L). The etiology and severity of AP were recorded. Differences between groups were calculated.
Of the 114 patients in the HL group, the common etiologies of AP were biliary (68%), iatrogenic trauma (14%), and idiopathic (10%). Only one patient had alcoholic AP. Conversely, the common etiologies of AP in the 146-patient comparison group (lipase 855–10,000 U/L) were broader: biliary (34%), idiopathic (23%), alcohol (14%), and iatrogenic trauma (10%). Biliary AP was twice as common in the HL group (P < 0.0001) whereas alcoholic AP was significantly less common (P < 0.0001). The positive predictive value (PPV) for biliary AP of lipase >10,000 U/L was 80% whereas the negative predictive (NPV) for alcoholic AP was 99%. No difference between groups was observed in the severity markers including ICU admission, length of hospital stay, complications, or mortality.
In AP a serum lipase of >10,000 U/L at presentation is a useful marker and portends a biliary etiology while virtually excluding alcoholic AP. Therefore, if ultrasonography is negative for stones in this population, these data suggest workup with MRCP or EUS is warranted to evaluate for microlithiasis or sludge given the high likelihood of occult stone disease in these individuals.
- Kingsnorth A, O’Reilly D. Acute pancreatitis. BMJ. 2006;332:1072–1076. CrossRef
- Whitcomb DC. Clinical practice. Acute Pancreatitis. N Engl J Med. 2006;354:2142–2150. CrossRef
- Forsmark CE, Baillie J, AGA Institute Clinical Practice and Economics Committee; AGA Institute Governing Board. AGA institute technical review on acute pancreatitis. Gastroenterology. 2007;132:2022–2044. CrossRef
- Tenner S, Dubner H, Steinberg W. Predicting Gallstone pancreatitis with laboratory parameters: a meta-analysis. Am J Gastroenterol. 1994;89:1863–1866.
- Yadav D, Agrawal N, Pitchumoni CS. A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol. 2002;97:1309–1318. CrossRef
- Gumaste VV, Dave PB, Weissman D, et al. Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from non-alcoholic acute pancreatitis. Gastroenterology. 1991;101:1361–1366.
- Tenner SM, Steinberg W. The admission serum lipase: amylase ratio differentiates alcoholic from non-alcoholic acute pancreatitis. Am J Gastroenterol. 1992;87:1755–1758.
- Lankisch PG, Peterson M. Lipase/amylase ratio: not helpful in the early etiological differentiation of acute pancreatitis. Z Gastroenterol. 1994;32:8–11.
- Hiatt JR, Calabria RP, Passaro E Jr, et al. The amylase profile: a discriminant in biliary and pancreatic disease. Am J Surg. 1987;154:490–492. CrossRef
- Kim YS, Lee BS, Kim SH, et al. Is there correlation between pancreatic enzyme and radiological severity in acute pancreatitis? World J Gastroenterol. 2008;14:2401–2405. CrossRef
- http://ssdi.rootsweb.ancestry.com/cgi-bin/ssdi.cgi. Accessed on January 15th, 2009.
- Blamey SL, Imrie CW, O’Neill J, et al. Prognostic factors in acute pancreatitis. Gut. 1984;25:1340–1346. CrossRef
- Imrie CW. Prognostic indicators in acute pancreatitis. Can J Gastroenterol. 2003;17:325–328.
- Lankisch PG, Mahlke R, Blum T, et al. Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol. 2001;96:2081–2085. CrossRef
- Göçmen E, Klc YA, Yoldaş O, et al. Comparison and validation of scoring systems in a cohort of patients treated for biliary acute pancreatitis. Pancreas. 2007;34:66–69. CrossRef
- Kemppainen EAJ, Hedstrom JI, Puolakkainen PA, et al. Advances in the laboratory diagnostics of acute pancreatitis. Ann Med. 1998;60:169–175. CrossRef
- Lankisch PG, Burchard-Reckert S, Lehmick D. Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis. Gut. 1999;44:542–544. CrossRef
- Vonlaufen A, Wilson JS, Apte MV. Molecular mechanisms of pancreatitis: current opinion. J Gastroenterol Hepatol. 2008;23:1339–1348. CrossRef
- Thrower E, Husain S, Gorelick F. Molecular basis for pancreatitis. Curr Opin Gastroenterol. 2008;24:580–585. CrossRef
- Gaisano HY, Gorelick FS. New insights into the mechanisms of pancreatitis. Gastroenterology. 2009;136:2040–2044. CrossRef
- Kimura Y, Arata S, Takada T, et al. Gallstone-induced acute pancreatitis. J Hepatob Pancreat Sci. 2010;17:60–69. CrossRef
- Ito K, Ito H, Whang EE. Timing of cholecystectomy for biliary pancreatitis: do the data support current guidelines? J Gastrointest Surg. 2008;12:2164–2170. CrossRef
- The Causes and Outcome of Acute Pancreatitis Associated with Serum Lipase >10,000 U/L
Digestive Diseases and Sciences
Volume 56, Issue 11 , pp 3376-3381
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- Acute pancreatitis
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- 1. Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, Madison, WI, 53705, USA
- 2. Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, Madison, WI, 53705-2281, USA