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Hyperamylasaemia and acute pancreatitis in paracetamol poisoning
Author(s) -
Schmidt L. E.,
Dalhoff K.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2004.02070.x
Subject(s) - medicine , acute pancreatitis , hyperamylasemia , pancreatitis , gastroenterology , incidence (geometry) , odds ratio , amylase , retrospective cohort study , biochemistry , chemistry , physics , optics , enzyme
Summary Background : Hyperamylasaemia and even acute pancreatitis have been reported in patients with paracetamol poisoning. Aims : To describe the incidence, clinical characteristics, and prognostic implications of hyperamylasaemia in paracetamol poisoning. Patients : Six hundred and two patients transferred to a specialized unit with severe paracetamol poisoning and 212 unselected patients admitted from the local region. Methods : Retrospective study based on hospital charts. The optimum threshold of serum amylase to discriminate non‐survivors was identified. Results : An elevated serum amylase (>100 U/L) occurred in 28 of the unselected patients (13%), in 218 of the transferred patients (36%), and in 118 of 148 patients (80%) with fulminant hepatic failure. Only 33 cases of paracetamol‐associated acute pancreatitis were diagnosed. A threshold serum amylase of 150 U/L to discriminate non‐survivors had sensitivity 76%, specificity 85%, positive predictive value 33%, and negative predictive value 97%. In a logistic regression analysis, a serum amylase > 150 U/L was associated with an excess mortality (odds ratio 5.0, 2.6–9.7). Conclusions : Hyperamylasaemia is frequent in patients with paracetamol poisoning, whereas clinical acute pancreatitis occurs rarely. The incidence of hyperamylasaemia increases with the degree of hepatic dysfunction. A serum amylase exceeding 1.5 times the upper normal limit indicates a poor prognosis.