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

摘要

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 andartificial ventilation, development of pseudocysts, necessity forsurgery, and mortality were taken as parameters of severity.
RESULTS—The incidenceof severity was the same for both the ⩽3n and >3n groups.
CONCLUSIONS—Theseverity of acute pancreatitis is independent of the elevation in serumamylase/lipase level (⩽3n or >3n) on admission. Patients with only aslight increase can also have or develop severe acute pancreatitis.Patients with ⩽3n elevated enzyme levels on admission represent asubstantial group that treatment studies have frequently overlooked.This is especially true for patients with alcohol induced acutepancreatitis whose amylase levels are lower than in other aetiological groups.

Keywords:acute pancreatitis; amylase; lipase; severity; prognosis; mortality