Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis

BACKGROUND In most treatment studies on acute pancreatitis, pancreatologists base their diagnosis on amylase/lipase levels more than three times above the upper limit of normal (>3n) and thus exclude patients with smaller enzyme level increases. The recommendations derived from the results of tre...

Full description

Saved in:
Bibliographic Details
Published in:Gut 1999-04, Vol.44 (4), p.542-544
Main Authors: Lankisch, P G, Burchard-Reckert, S, Lehnick, D
Format: Article
Language:English
Subjects:
Acute Disease
acute pancreatitis
Alcohol
Alcoholism
amylase
Amylases - blood
Biological and medical sciences
Biomarkers - blood
Clinical Enzyme Tests
Cysts
Disease
Endoscopy
Enzymes
Gangrene
Gastroenterology. Liver. Pancreas. Abdomen
Hospitals
Humans
lipase
Lipase - blood
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Mortality
Other diseases. Semiology
Pancreatic Disease
Pancreatitis - diagnosis
prognosis
Retrospective Studies
severity
Severity of Illness Index
Studies
Ultrasonic imaging
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:BACKGROUND In most treatment studies on acute pancreatitis, pancreatologists base their diagnosis on amylase/lipase levels more than three times above the upper limit of normal (>3n) and thus exclude patients with smaller enzyme level increases. The recommendations derived from the results of treatment studies do not take into account such patients. Non-pancreatologists frequently believe that only patients with high enzyme levels have a serious prognosis. AIMS To question the assumption that high enzyme levels indicate severe, and conversely low enzyme levels indicate mild, acute pancreatitis. PATIENTS/METHODS This retrospective study includes 284 consecutive patients with a first attack of acute pancreatitis. The cause was biliary in 114 (40%) patients, alcoholism in 83 (29%), other in 21 (7%), and unknown in 66 (23%). Patients were divided into two groups according to their serum enzyme levels (amylase: ⩽3n, n = 88; >3n, n = 196; lipase: ⩽3n, n = 51; >3n, n = 233). Renal impairment, indication for dialysis and artificial ventilation, development of pseudocysts, necessity for surgery, and mortality were taken as parameters of severity. RESULTS The incidence of severity was the same for both the ⩽3n and >3n groups. CONCLUSIONS The severity of acute pancreatitis is independent of the elevation in serum amylase/lipase level (⩽3n or >3n) on admission. Patients with only a slight increase can also have or develop severe acute pancreatitis. Patients with ⩽3n elevated enzyme levels on admission represent a substantial group that treatment studies have frequently overlooked. This is especially true for patients with alcohol induced acute pancreatitis whose amylase levels are lower than in other aetiological groups.
ISSN:0017-5749
1468-3288
1458-3288
DOI:10.1136/gut.44.4.542