Can serum and peritoneal amylase and lipase determinations help in the early prognosis of acute pancreatitis?

Serum and peritoneal amylase and lipase levels were determined at an early stage in 73 patients with acute pancreatitis confirmed by computed tomography (CT scan), surgery, and/or postmortem. Each patient was given an enzymatic score (ES), which reflects the predominance of the serum or peritoneal concentration of the two enzymes, as the case may be. This score can thus be either 0, 1, or 2; ES = 0 if neither enzyme is predominant in the peritoneal fluid, ES = 1 if amylase or lipase alone are predominant therein, and ES = 2 if both enzymes are predominant. This enzymatic score appears to be a good indicator of severity of disease, being as it is directly and significantly related to mortality rate, prognostic score as proposed by Ranson, and incidence of extrapancreatic spreads as demonstrated by CT scan. In 38 patients (including two fatalities) with an enzymatic score of 0 or 1, mortality was 5%, whereas in 35 patients (10 fatalities) with ES = 2, mortality was 29% (p less than 0.01).