Emergency patients with mild elevations of serum lipase and acute pancreatitis

Abstract

Objectives: To estimate the incidence of AP and determine potential predictors and the outcomes. Elevated lipase level of <3 times the upper limit of normal (ULN) cause diagnostic confusion for acute pancreatitis (AP).

Methods: A multicenter, 6-year retrospective study enrolled adult patients who were detected with lipase level of 80-240 IU/L in the Emergency Department (ED). The Revised Atlanta Classification was used to identify AP within 72 hour (hr) from the first ED visit.

Results: Of 1082 patients, 68 (6.3%) had AP, 393 (36.3%) were hospitalized, 64 (6%) required intensive care unit admission, and 2 (0.2%) died. Most AP cases were confirmed using computed tomography CT; 47 (69.1%), followed by repeated lipase level 15 (22.1%) and ultrasound 14 (20.6%). Alcohol exhibited the highest adjusted odds ratio of predicting AP (3.9-45.6), followed by white blood cell count (1.340-6.222), male gender (1.451-4.308), and higher lipase level (1.009-1.02). Among AP cases, 11.8% required ICU admission and 1 died within 72 hr. Chronic heart disease, obesity, fever, and tachycardia were associated with these critical outcomes.

Conclusion: Among the study sample, 6.3% were diagnosed with AP. Most of the cases confirmed by CT and alcohol was the strongest risk factor in predicting AP. A prediction score system to stratify AP risk when lipase is <3 ULN is warranted.

Keywords: acute pancreatitis; emergency; lipase; mild elevations.

Figure 1

- Distribution of the number of patients with confirmed acute pancreatitis according to diagnostic tests. CT: computed tomography, US: ultrasound