[Clinical usefulness of the determination of the lipase/elastase ratio and of the polymorphonuclear elastase in the hospital admission of the patient with acute pancreatitis]

Abstract

Objective: The clinical usefulness of the determination of polymorphonuclear elastase in serum, in patients with acute pancreatitis as a predictive value of severity.

Material and methods: A prospective study was made of 60 patients who at admission in the hospital showed high rates not only of lipase but also of polymorphonuclear elastase. High rates of this enzyme have been statistically related with the severity of pancreatitis. This severity is expressed by multifactorial Glasgow prognostic factors and by Ranson's CT degree. The predictive value in the evolution of the disease has been related to the need for surgery and related to the number of hospitalization days in non-operated patients. All these factors have been analysed taking into account such variables as age, sex, and biliary origin of the acute pancreatitis.

Results: Our study shows no statistically significant correlation between high polymorphonuclear (pmn) elastase serum levels in patients with acute pancreatitis (AP) and their evolution (as evaluated by means of clinical signs and CT images). In other words, determination of high pmn elastase serum levels has no predictive value to indicate the degree of severity in AP. Finally, we have found no clinical use in the lipase/ amylase ratio, neither as a predictive value in the evolution of our AP patients nor as a diagnostic tool to aid in the distinction among AP of biliary origin and AP due to other causes.

Conclusion: The severity of acute pancreatitis must be evaluated according to clinical parameters and CAT scan imaging.