Lipase elevation on admission predicts worse clinical outcomes in patients with COVID-19

Background and objectivesHyperlipasemia is highly prevalent among coronavirus disease 2019 (COVID-19) patients. The aim of this study was to assess the effect of lipase activity, measured at the time of admission, on the clinical course and mortality in COVID-19 patients.MethodsThe population of this study comprised 12,139 patients who were hospitalized due to COVID-19 between June 2020 and June 2021 in a pandemic hospital. Of these, 8819 patients were excluded from the study due to missing data, four patients were excluded due to a diagnosis of acute pancreatitis (according to the revised Atlanta criteria), and 72 patients were excluded due to alcohol use or having a history of chronic pancreatitis. The final study sample consisted of the remaining 3244 COVID-19 patients. Laboratory results, intensive care unit (ICU) follow-up periods, the need for mechanical ventilation, and mortality rates were compared between the normal lipase activity and high lipase activity groups.ResultsThere were 968 (29.8%) patients with high lipase activity at the time of admission. The rate of ICU admission was 36.1% vs. 9.9% (p < 0.001), mechanical ventilation requirement rates were 33.7% vs. 8.3% (p < 0.001), and mortality rates were as 24.6% vs. 6.4% (p < 0.001) in the high lipase activity group compared to the normal lipase activity group. Multivariate regression analysis revealed that high lipase activity was an independent factor in predicting mortality in hospitalized COVID-19 patients (odds ratio [OR]: 3.191, p < 0.001).ConclusionElevated lipase activity without acute pancreatitis at the time of admission in COVID-19 patients was determined as an independent predictor of poor prognosis.     

从猪胰脏中提取胰酶的优化工艺探索化学教研室

对猪胰脏中提取胰酶的多种条件进行了详细研究。在本文条件下，胰蛋白酶、胰脂肪酶、胰淀粉酶三酶活力分别达４２００ｕ／ｇ，３６００ｕ／ｇ，５０００ｕ／ｇ以上，收率１０－１３％。     

Non-linearity and gaps in results distribution over successive Roche Lipase method applications: improvement but persistence

Abstract

Non-linearity within the primary measurement range of a lipase assay (<300?U/L) has been shown on Cobas^® Roche analyzers, causing gaps in results distribution between 300 and 400?U/L. Since, new lipase method applications (LMAs) have been used. The purpose is to retrospectively evaluate their impact on relative frequencies of lipase results (RFLs).

Plasma lipase results from two hospital laboratories, assayed over 7.2?years, were collected. Over this period, three successive LMAs, characterized by automated repeat-on-dilution (1/11, 1/2, or 1/10), were applied for lipase results >300?U/L: LMA1 and LMA2 on the Modular^®P800, Cobas^®c501 and Cobas^®C701 analyzers, and LMA3 on the Cobas^®C701. RFLs were determined, linearity tests were performed, and inter-agreements between lipase results corrected and uncorrected for nonlinear biases were assessed, using 180?U/L as a decisional cut-off for acute pancreatitis.

Overall, RFL gaps narrowed from LMA1 (300 to ～380?U/L) to LMA3 (300 to ～330?U/L). For a lipase activity fixed at 300?U/L, non-linearity biases were determined at ?11.2% on the Modular^®P800 (LMA1), ?20.8% on the Cobas^®c501 (LMA1), and ?3.5% (LMA2) and ?2.2% (LM3) on the Cobas^®C701. Diagnostically, a maximum of 0.48% lipase results were misclassified as negative (LMA1 on the Cobas^®c501), and a minimum of 0.01% misclassified as negative (LMA3 on the Cobas^®C701). In conclusion, successive Roche lipase method applications improved linearity within the primary measurement range. While persisting, gaps in lipase results distribution narrowed with the evolution of the methods, with a minor impact in terms of diagnostic of acute pancreatitis.     

Bilateral vagotomy attenuates the severity of secretagogue-induced acute pancreatitis in the rat

PurposeWe assessed the effect of bilateral vagotomy (BV) on the course of acute caerulein-induced pancreatitis (AP) in the rat.Material/methodsThe study was performed on Wistar rats surgically prepared by subdiaphragmatic BV. Control group underwent sham operation. Four days later, AP was induced by subcutaneous injection of caerulein (25 μg/kg/5 h) to the conscious animals with or without BV. After administration of caerulein the blood samples were taken for determination of serum lipase activity and interleukin-10 (IL-10) concentration. Pancreatic tissue samples were subjected to histological examinations and to the measurement of lipid peroxidation products (MDA + 4-HNE) concentration and the activity of an antioxidant enzyme – glutathione peroxidase (GPx). After application of caerulein pancreatic blood flow was measured by laser Doppler flowmetry.ResultsAP was manifested by oedema and neutrophil infiltration of the pancreatic tissue and accompanied by significant increases of serum lipase activity, serum concentration of IL-10 and pancreatic concentration of MDA + 4HNE (ca. 50×, 2× and 4× respectively p ≥ 0.05). Pancreatic activity of GPx and pancreatic blood flow were decreased (both by 60%). In vagotomised rats with AP serum lipase activity and pancreatic concentration of MDA + 4-HNE were lower whereas Il-10 concentration and pancreatic activity of GPx, as well as pancreatic blood flow were significantly higher as compared to AP rats with intact vagal nerves. In AP rats with vagotomy all histological signs of pancreatitis were significantly reduced.ConclusionsBilateral vagotomy resulted in the significant attenuation of caerulein-induced pancreatitis in the rat.     

Prevalence and prognosis of increased pancreatic enzymes in patients with COVID-19: A systematic review and meta-analysis

IntroductionThe prevalence of increased pancreatic enzymes (elevated serum amylase and/or lipase) and its relationship to clinical outcomes in patients with coronavirus disease 2019 (COVID-19) infection is not known.MethodsA systematic review and meta-analysis of relevant studies reporting prevalence and impact of increased pancreatic enzymes (defined as an elevation in amylase and/or lipase levels above the upper limit of normal [ULN] value) in COVID-19 was undertaken.ResultsA total of 36,496 patients from 21 studies were included for this meta-analysis. The overall prevalence and mortality for increased pancreatic enzymes (>ULN) in COVID-19 were 25.4% (95% CI, 15.8%–36.2%) and 34.6% (95% CI, 25.5%–44.4%), respectively. The overall prevalence and mortality for increased pancreatic enzymes (>3 × ULN) were 6.1% (95% CI, 3.6%–9.2%) and 39.2% (95% CI, 18.7%–61.6%), respectively. Patients with increased pancreatic enzymes, including elevated serum lipase or amylase of either type, had worse clinical outcomes, including need for ICU admission, mechanical ventilation and mortality.DiscussionIncreased pancreatic enzymes is frequent and may exacerbate the consequences of COVID-19 infection.     

内皮脂肪酶与高密度脂蛋白及动脉粥样硬化的关系

高密度脂蛋白具有一定的抗动脉粥样硬化的作用,而内皮脂肪酶可水解高密度脂蛋白,进而影响动脉粥样硬化的进展,故深入探讨三者关系,可能为动脉粥样硬化相关疾病的防治提供崭新的靶点.     

脂蛋白脂酶基因PvuⅡ多态性与脑梗死的观察分析

目的 探讨脂蛋白脂酶基因PvuⅡ多态性与脑梗死的关系。方法 采用聚合酶链反应和限制性片段长度多态性方法,对67例脑梗死患者和81例正常对照组脂蛋白脂酶基因第6号内含子PvuⅡ酶切位点进行多态性分析。结果 （1）正常对照组PvuⅡ等位基因频率分别为P＋63％、P-37％;脑梗死组PvuⅡ等位基因频率分别为P＋60．5％、P-39．5％;脂蛋白脂酶基因PvuⅡ等位基因频率在脑梗死组与正常对照组之间的差异无统计学意义;（2）与正常对照组相比,脑梗死患者组血清TG、CHO、LDL-c水平较对照组升高（P〈0．05）;脑梗死患者组血清apoAⅠ水平较对照组降低（P〈0．05）。结论 脂蛋白脂酶PvuⅡ酶切多态性与脑梗塞发病无明显关联。     

血清脂肪甘油三酯脂肪酶水平与肥胖和糖尿病的相关性

目的通过检测肥胖和新诊断2型糖尿病患者的血清脂肪甘油三酯脂肪酶（adiposetfiglycefidelipase,ATGL）水平,探讨ATGL与糖、脂代谢的相关性。方法选取2006年8月至2009年4月在江苏大学附属医院门诊和内分泌科住院患者114例,其中男54例,女60例,年龄38-70岁。分为2型糖尿病患者66例和正常糖调节者48例,再按体质指数（BMI）是否≥25kg／m^2分为4组：2型糖尿病-超重组、正常糖调节-超重组、2型糖尿病．正常体重组和正常糖调节．正常体重组,检测空腹血糖、血脂和空腹胰岛素（FINS）、ATGL水平,并计算BMI、腰臀比、体脂含量和胰岛素抵抗指数（HOMA-IR）。分别进行t检验、直线相关分析、多元逐步回归分析。结果（1）血清ATGL水平在2型糖尿病-超重组为（239±61）μg／L,与2型糖尿病-正常体重组[（355±54）μg／L]相比,差异有统计学意义（t=22．53,P〈0．05）;而正常糖调节-超重组[（242±60）μg/L]与正常糖调节-正常体重组[（383±58）μg/L]相比,差异也有统计学意义（t=8．23,P〈0．05）。（2）简单相关分析发现,血清ATGL浓度与体脂含量、BMI、腰臀比、甘油三酯、HOMA．IR等呈负相关（r值分别为-0．271、-0．238、-0．375、-O．313、-0．164,均P〈0．05）。多元逐步回归分析发现腰臀比、体脂含量为血清ATGL的独立相关因素。结论肥胖者的血清ATGL水平明显低于正常体重者,ATGL与腰臀比、体脂含量呈独立相关,而与血糖无明显相关。