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Evaluation of amylase and lipase in the diagnosis of acute pancreatitis
Author(s) -
Treacy John,
Williams Anthony,
Bais Renz,
Willson Krysten,
Worthley Christopher,
Reece John,
Bessell Justin,
Thomas David
Publication year - 2001
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1046/j.1445-2197.2001.02220.x
Subject(s) - medicine , lipase , amylase , pancreatitis , receiver operating characteristic , acute pancreatitis , gastroenterology , area under the curve , isoamylase , diagnostic accuracy , pancreatic disease , endocrinology , enzyme , pancreas , biochemistry , biology
Background : The diagnosis of acute pancreatitis relies heavily on a raised amylase. Methods : In the present study patients were prospectively categorized, without knowledge of pancreatic enzyme levels, into acute pancreatitis (AP; n = 51), disease controls ( n = 35), indeterminate as to pancreatitis ( n = 189) or exclusions (non‐pancreatitis diseases where amylase may be elevated; n = 53). Results : Enzyme levels were analysed by receiver operator characteristics (ROC) curves, with specificity > 80%. Day 1 serum lipase gave the greatest diagnostic accuracy (area under ROC curve = 0.128; P = 0.041 vs serum amylase). At the calculated diagnostic threshold of 208 U/L, lipase gave a sensitivity of 67% and a specificity of 97%. Other diagnostic thresholds (day 1) were: serum total amylase, 176 U/L (ROC 0.104, sensitivity 45%, specificity 97%), urinary total amylase, 550 U/L (ROC 0.108, sensitivity 62%, specificity 97%) and serum pancreatic isoamylase, 41 U/L (ROC 0.107, sensitivity 63%, specificity 85%). At delayed diagnosis (3 days) no enzyme was superior to lipase. The combination of lipase and amylase did not increase diagnostic accuracy. Conclusion : Serum lipase is recommended for diagnosis of AP, both early and late in the disease. Although highly specific when elevated, all pancreatic enzymes have low sensitivity for diagnosis.