Underestimation of acute pancreatitis: patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis |
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Authors: | Lankisch P G Burchard-Reckert S Lehnick D |
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Affiliation: | Department of Internal Medicine, Municipal Hospital of Lüneburg, Lüneburg, Germany. |
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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. |
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