Title: Role of Serum Amylase and Lipase Levels in the Classification of Acute Pancreatitis According to Revised Atlanta Classification

Authors: Dr Ajay Alex, Dr Josey Verghese, Dr Saji Kumar, Dr K.B.Salim

 DOI:  https://dx.doi.org/10.18535/jmscr/v5i3.177

Abstract

Introduction: Revised Atlanta classification proposed the use of morphologic CECT criteria to diagnose the specific type of acute pancreatitis into acute interstitial oedematous pancreatitis (IEP) or acute necrotizing pancreatitis. The total serum amylase test is most frequently ordered to diagnose acute pancreatitis, because it can be measured quickly and cheaply. In acute pancreatitis, the serum amylase concentration is usually more than 2 to 3 times the upper limit of normal. Lipase is considered as the most sensitive and specific marker for acute pancreatitis currently used in clinical practice. The aim of this study was to evaluate for any correlation of radiological imaging features in acute pancreatitis with pancreatic enzyme levels.

Materials and Methods: This was a descriptive study involving 67 study subjects suspected to have acute pancreatitis who underwent CECT Abdomen in the department from January 2015 to June 2016. Imaging findings were defined as per Revised Atlanta classification in addition to obtaining serum amylase and lipase values. Data collected were analysed using statistical tools.

Results: Mean values for serum amylase for IEP was 1127.39 and 1572.74 for necrotising pancreatitis. Mean values for serum lipase for IEP was 1390.39 and 2401.03 for necrotising pancreatitis. Independent sample t test was done to compare mean values of serum pancreatic enzyme levels in specific type of pancreatitis. Though the mean values were found to be higher for necrotising pancreatitis, no significant association (p value < 0.05) was found between the enzyme level and the type of pancreatitis.

Conclusion: Pancreatic enzyme evaluation was observed to aid in diagnosing acute pancreatitis; however their levels were not significant to predict the type of pancreatitis as defined by Revised Atlanta classification.

Keywords-acute pancreatitis, amylase, lipase, Revised Atlanta classification, computed tomography.

References

1.      Frossard JL, Steer ML, Pastor CM. Acute pancreatitis. Lancet 2008; 371(9607):143–52.

2.      Fagenholz PJ, Castillo CF, Harris NS, et al. Increasing United States hospital admissions for acute pancreatitis 1988-2003. Ann Epidemiol 2007; 17:491-7.

3.      DeFrances CJ, Hall MJ, Podgornik MN. 2003 National Hospital Discharge Survey: Advance data from vital and health statistics. Hyattsville, Md: National Center for Health Statistics. 2005.

4.      Frey CF, Zhou H, Harvey DJ, White RH. The incidence and case-fatality rates of acute biliary, alcoholic, and idiopathic pancreatitis in California, 1994-2001. Pancreas 2006; 33:336-44.

5.      Revision of the Atlanta classification of acute pancreatitis, April 9, 2008; Available from:http://pancreasclub.com/wpcontent/ uploads/2011/11/AtlantaClassification.pdf.

6.      Agarwal N, Pitchumoni CS, Sivaprasad AV. Evaluating tests for acute pancreatitis. Am J Gastroenterol 1990; 85:356-66.

7.      Sternby B, O’Brien JF, Zinsmeister AR, et al. What is the best biochemical test to diagnose acute pancreatitis? A prospective clinical study. Mayo Clin Proc 1996; 71:1138-44.

8.      Kimmel P, Tenner S, Habwe VQ, et al. Trypsinogen and other pancreatic enzymes in patients with renal disease: A comparison of high efficiency hemodialysis and continuous ambulatory peritoneal dialysis. Pancreas 1995; 10:325-30.

9.      Gullo L. Familial pancreatic hyperenzy-memia. Pancreas 2000; 20:158-60.

10.  Gwodz GP, Steinberg WM, Werner M, et al. Comparative evaluation of the diagnosis of acute pancreatitis based on serum and urine enzyme assays. Clin Chim Acta 1990; 187:243-54.

11.  Kristin L. MacArthur, Camilia R. Martin, Tyler M. Berzin, Nathan I. Shapiro, Sunil Sheth, Mandeep Sawhney. Lipase: A Poor Diagnostic Marker for Acute Pancreatitis in the Intensive Care Unit. May, 2013; 144(5)1:S-278.

12.  Steinberg WM, Rosenstock J, Devries JH et al. Elevated serum lipase activity in adults with type 2 diabetes and no gastrointestinal symptoms. DDW, 2012; 422:A114.

13.  Keim, Teich, Fiedler, Hartig, Thiele, Mössner. A Comparison of Lipase and Amylase in the Diagnosis of Acute Pancreatitis in Patients with Abdominal Pain. Pancreas, January 1998.

Corresponding Author

Dr Ajay Alex

Department of Radiodiagnosis

Government TD Medical College, Alappuzha, Kerala, India