2006/09/01 by Abbasi J. Akhtar, Magda A. Shaheen, Magda Shaheen
Medicine · #Pancreatitis Pathology and Treatment
paper · doi:10.14309/00000434-200609001-00188
Purpose: Diagnosis of acute pancreatitis is most often based upon clinical picture and serum amylase and lipase levels more than three times of normal (>3n). Some patients with acute severe pancreatitis, with smaller degree of enzyme elevations may be missed or considered to be having only mild pancreatitis, that could result in delaying intensive care management and timely interventions. Our objective was to determine the association of pancreatic enzyme elevation with the severity of first attack of acute pancreatitis. Methods: Retrospective review of medical records of 433 patients aged 18–95 years with a diagnosis of first attack of acute pancreatitis over 15-year period (238 African-American and 195 Hispanic). Using the 3n criteria of pancreatic enzymes level, patients were divided into two groups (≤3n & >3n). Study criteria of severity included: type of acute pancreatitis (interstitial or necrotizing), presence of extra pancreatic manifestations (EPM), necessity for surgery, and mortality. Results: Of the 433 subjects, the etiology was alcohol in 230 (53%) and gallstones in 182 (42%). Eighteen percent of patients had necrotizing pancreatitis, 15% had EPM, 3% needed surgery and 12% died. According to the amylase level, 329 patients (76%) had level >3n and 104 patients (24%) had ≤3n. For the lipase level, 355 patients (82%) had >3n and 78 patients (18%) had ≤3n. There was no association between the level of amylase or lipase enzymes and the indicators of severity of first attack of acute pancreatitis or mortality (p>0.05). Conclusions: The magnitude of elevation of serum amylase/lipase was not associated with the severity of first attack of acute pancreatitis in our study population. The clinicians should have a high index of suspicion for the diagnosis and low threshold for computerized abdominal tomography, in order to detect obscure severe acute pancreatitis.