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Gut. 1999 Apr;44(4):542-4.

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

Author information

1
Department of Internal Medicine, Municipal Hospital of L√ľneburg, L√ľneburg, Germany.

Abstract

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.

PMID:
10075962
PMCID:
PMC1727444
[Indexed for MEDLINE]
Free PMC Article
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