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

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.