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.
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.
Authors: H Goebell; R Ammann; C Herfarth; J Horn; J Hotz; M Knoblauch; M Schmid; M Jaeger; A Akovbiantz; E Linder; K Abt; E Nüesch; E Barth Journal: Scand J Gastroenterol Date: 1979 Impact factor: 2.423
Authors: F Paul; E E Ohnhaus; R D Hesch; G Chemnitz; R Hoppe-Seyler; H R Henrichs; H Hartung; D Waldmann; K Kunze; E Barth; E Nüesch; K Abt Journal: Dtsch Med Wochenschr Date: 1979-04-27 Impact factor: 0.628
Authors: M Büchler; P Malfertheiner; W Uhl; J Schölmerich; F Stöckmann; G Adler; W Gaus; K Rolle; H G Beger Journal: Gastroenterology Date: 1993-04 Impact factor: 22.682
Authors: Michael H Ma; Harrison X Bai; Alexander J Park; Sahibzada U Latif; Pramod K Mistry; Dinesh Pashankar; Veronika S Northrup; Vineet Bhandari; Sohail Z Husain Journal: J Pediatr Gastroenterol Nutr Date: 2012-05 Impact factor: 2.839
Authors: T Cartier; P Sogni; F Perruche; O Meyniard; Y-E Claessens; J-F Dhainaut; G Der Sahakian Journal: Emerg Med J Date: 2006-09 Impact factor: 2.740
Authors: Tiffany Philips; Irina Kusmartseva; Ivan C Gerling; Martha Campbell-Thompson; Clive Wasserfall; Alberto Pugliese; Jeffrey A Longmate; Desmond A Schatz; Mark A Atkinson; John S Kaddis Journal: Pancreas Date: 2017-02 Impact factor: 3.327
Authors: Paul A Sutton; David J Humes; Gemma Purcell; Janette K Smith; Frances Whiting; Tom Wright; Linda Morgan; Dileep N Lobo Journal: Ann R Coll Surg Engl Date: 2009-04-30 Impact factor: 1.891