EP.FRI.353 Repeat Amylase in Acute Pancreatitis

Abstract Introduction Acute pancreatitis is a common reason for acute surgical admission, with an annual incidence of 56 per 100,000 UK population. Studies have demonstrated that whilst serum amylase measurement is useful as a diagnostic tool, it has no correlation with disease severity, and its measurement after diagnosis has limited value. The aim of this audit was to review the practice of obtaining repeat serum amylase levels in patients diagnosed with acute pancreatitis in two district hospitals within the same health board. Secondary outcome was to gain up-to-date demographic information on the patient cohort. Methods This was a retrospective study, which reviewed records of those patients admitted with pancreatitis over a one-year period (January 2019 – December 2019). Electronic records were evaluated to check if serum amylase was repeated after diagnosis. Data on demographics, underlying cause and the use of CT for diagnosis were also collected. Results 174 patients were admitted during the study period, of which 53% (92) had their serum amylase inappropriately repeated. 14% (24) of cases were diagnosed using CT imaging. There was a 0.74:1 male to female ratio with an average age of 53. 51% of cases were caused by gallstones, 15% were caused by alcohol and 28% of cases had no identified cause. Conclusions Validated scoring systems remain the accepted method of predicting acute pancreatitis severity. This study highlights the frequent practice of inappropriately repeating serum amylase measurement in patients already diagnosed with acute pancreatitis. It also highlights the importance of CT scanning as a diagnostic tool.

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Clinical pattern of acute pancreatitis in eastern India and comparison of Ranson, BISAP and APACHE II as a predictor of severity, local complications and mortality

International Surgery Journal ◽

10.18203/2349-2902.isj20184649 ◽

2018 ◽

Vol 5 (11) ◽

pp. 3707 ◽

Cited By ~ 1

Author(s):

Nishith M. Paul Ekka ◽

Gaurav Mishra ◽

Vinod Kumar ◽

Arun Kumar Tiwary ◽

Tanushree Kar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Hospital Admissions ◽

Scoring Systems ◽

Apache Ii ◽

Aetiological Factor ◽

Serum Lipase ◽

Clinical Pattern ◽

Local Complications ◽

Complications And Mortality

Background: Acute pancreatitis is the single most frequent gastrointestinal cause of hospital admissions. Scoring systems have been used since the 1970s for assessment of its severity. This study was aimed to assess the clinical pattern of acute pancreatitis and to compare various predicting systems like Ranson, BISAP and APACHE II in predicting severity, local complications and mortality in acute pancreatitis.Methods: In this prospective study, 91 consecutive cases of acute pancreatitis admitted, between April 2015 to March 2017, were studied. The diagnostic criteria include the presence of at least two of the three features; abdominal pain, serum amylase and lipase levels and findings on imaging studies. Patients were divided into two groups each, BISAP Ranson ≥3 and <3, APACHE II ≥8 and <8, and analyzed statistically.Results: Out of total of 91 patients, 81 were male and 14 were female with mean age was 36.14 years. Commonest aetiological factor was alcoholism in 57.89% followed by gallstones in 23.16%. Serum amylase was raised in 83.26% patients while 95.79% had raised serum lipase levels. 75.79% patients were of MAP while 24.21% patients were of MSAP and SAP. 7.37% patients developed local complications and mortality rate was 6.32%. All the scoring systems were found similar in predicting severity, local complication and mortality, had low sensitivity and high specificity (P value < 0.05).Conclusions: There is no ideal predicting system for acute pancreatitis. These scoring systems can be used to triage patients for better healthcare delivery.

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Asymptomatic and Persistent Elevation of Pancreatic Enzymes in an Ulcerative Colitis Patient

Case Reports in Gastrointestinal Medicine ◽

10.1155/2013/415619 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Elisa Liverani ◽

Filippo Leonardi ◽

Lucia Castellani ◽

Carla Cardamone ◽

Andrea Belluzzi

Keyword(s):

Ulcerative Colitis ◽

Acute Pancreatitis ◽

Serum Amylase ◽

Drug Dosage ◽

Pancreatic Disease ◽

Pancreatic Enzymes ◽

Pancreatic Damage ◽

Bowel Diseases ◽

One Year ◽

Asymptomatic Elevation

Azathioprine has been extensively used in the management of inflammatory bowel diseases. It might cause pancreatic damage in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis. Here we report the case of a 61-year-old patient with ulcerative colitis who had been treated with azathioprine for three years, achieving clinical remission. During treatment he presented an asymptomatic elevation of serum pancreatic enzymes, without any signs of pancreatitis at imaging. This evidence brought us to reassess the drug dosage, without achieving a normalization of biochemical analysis. Autoimmune pancreatitis was excluded. One year after the suspension of azathioprine, we still face persistent high levels of amylase/lipase. Normalization of enzymatic values in patients who develop intolerance to azathioprine, in the form of either asymptomatic elevation in serum amylase/lipase or overt acute pancreatitis, is usually achieved in about two months after stopping drug intake. Asymptomatic elevation in serum pancreatic enzymes in the absence of pancreatic disease is reported in the literature and defined as “Gullo’s syndrome,” but nobody of the subjects studied had been treated in the past with pancreatotoxic drugs. Might this case be defined as “benign pancreatic hyperenzymemia”?

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Acute pancreatitis

Current Surgical Guidelines ◽

10.1093/med/9780198794769.003.0039 ◽

2018 ◽

pp. 371-378

Author(s):

Abdullah Jibawi ◽

Mohamed Baguneid ◽

Arnab Bhowmick

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Alcohol Abuse ◽

Inflammatory Response ◽

Organ Failure ◽

Nutritional Support ◽

Supportive Therapy ◽

Scoring Systems ◽

Ct Scanning ◽

Systemic Inflammatory Response

Acute pancreatitis presents with severe abdominal pain and systemic inflammation. Raised amylase is still the cornerstone of diagnosis along with CT scanning where diagnosis is uncertain. Causes include gallstones, alcohol abuse, and hypertriglyceridaemia. Therapy centres on supportive therapy and managing systemic inflammatory response/organ failure. Scoring systems are described which help predict severity of the attack, as well as nutritional support and treatment of complications (necrosis, pseudocyst).

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Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

Bangladesh Journal of Child Health ◽

10.3329/bjch.v40i3.33057 ◽

2017 ◽

Vol 40 (3) ◽

pp. 160-165

Author(s):

Nadira Musabbir ◽

ASM Bazlul Karim ◽

Md Wahiduzzaman Mazumder ◽

Kaniz Sultana ◽

Syeda Afria Anwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Serum Amylase ◽

Abdominal Mass ◽

Elevated Serum ◽

Clinical Feature ◽

Cross Sectional ◽

Female Ratio ◽

Epigastric Region ◽

Common Location

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

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Comparison of bedside index of severity in acute pancreatitis (BISAP) and acute physiology and chronic health evaluation (APACHE II) score in assessing severity of acute pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20175409 ◽

2017 ◽

Vol 4 (12) ◽

pp. 4054

Author(s):

S. K. Pattanaik ◽

V. Arvind Kumar ◽

Ajax John

Keyword(s):

Acute Pancreatitis ◽

Sensitivity And Specificity ◽

Roc Curve ◽

Scoring System ◽

Scoring Systems ◽

Apache Ii ◽

High Rate ◽

Apache Ii Score ◽

Average Hospital ◽

Female Ratio

Background: Acute Pancreatitis (AP) is one among the major diseases in the surgery wards with high rate of mortality. In spite of many scoring systems introduced to grade the severity of AP for optimal and timely management, mortality rate is still in a high pace. The aim of this study is to compare BISAP scoring system and APACHE II scoring system for accuracy and easiness in predicting the severity and mortality of AP and to deliver appropriate and timely intervention.Methods: The first 100 patients with AP in the year 2016 (January to August) were studied prospectively by calculating APACHE II score and BISAP score. According to Revised Atlanta classification severe AP was ascertained and the sensitivity and specificity of both scoring systems were assessed from chi square table. By using ROC curve accuracy and diagnostic value of two scoring systems were compared.Results: 100 patients with an age ranging from 20 to 80 years with a mean of 41.18 and male female ratio of 10.1:1 were studied. 95% of the patients presented with a symptom of abdominal pain and 49 out of 100 were having alcoholism as etiology. The average hospital stay of the patients was 12.03 days. Four patients died out of 11 severe AP and rest 89 were grouped into mild AP. BISAP score more than or equal to three have 64.2% chance of severe AP and was statistically significant in predicting the severity of AP. Areas under curve of the ROC curve after depicting the sensitivity and specificity of BISAP scores for severity and mortality were 0.90 and 0.96 respectively. APACHE II scores more than or equal to nine have 23.8% chance of severe AP and was statistically significant in predicting severity of AP. When sensitivity and specificity of APACHE II score were charted in ROC curve, areas under curve were 0.853 and 0.75 for severity and mortality in AP respectively.Conclusions: Compared to APACE II, BISAP is better scoring system in predicting both severity and mortality of AP on considering accuracy and easiness.

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TO STUDY THE INCIDENCE, ETIOLOGY AND CORRELATION BETWEEN SERUM AMYLASE LEVELS AND BALTHAZAR SCORE (SEVERITY) IN PATIENTS OF ACUTE PANCREATITIS AT TERTIARY CARE HOSPITAL

10.36106/ijsr/1636450 ◽

2020 ◽

pp. 1-3

Author(s):

Snehal N. Purandare ◽

Aishwarya U. Chavan ◽

Brijesh U. Patil

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Age Groups ◽

Care Hospital ◽

Normal Range ◽

Female Ratio ◽

Common Cause ◽

Presenting Symptoms ◽

Number Of Patients ◽

The Mean

Acute pancreatitis is a heterogeneous disease ranging from minimal pancreatic inflammation seen in mild interstitial pancreatitis to extensive pancreatic necrosis and liquefaction of severe attacks. The incidence of acute pancreatitis is 33.3 per 100,000 population. Maximum number of patients with acute pancreatitis belong to the age groups of 26 – 35 years and 36- 45 years with 34.8% of cases in each of the mentioned age groups. The mean age of presentation was 39 years. Out of the 89 patients who were diagnosed with pancreatitis, only 5 patients were females while all others were males. The male to female ratio was 16.8: 1 with male preponderance. On presentation, all 89 patients (100%) had pain in abdomen, 89.9% of the cases had vomiting and 64% of the cases had radiating back pain as the presenting symptoms. Alcohol abuse was found to be the most common cause of pancreatitis isolated in 89.9% of the patients which explains the 16.8:1 male female ratio. The second most common cause was gallstone induced pancreatitis (9%) while idiopathic pancreatitis was found in 1.1% of the cases. None of the patients had other rare causes of pancreatitis amongst the miscellaneous category. The sensitivity of serum amylase was 84.3% while the specificity of serum amylase was 55.9%. For Balthazar score (inflammation) 1, 2, 3 the mean serum amylase value (U/L) was 696.5, 829.6 and 822.0 respectively. [Normal Range: 22 – 80U/L in our institute] For Balthazar score (necrosis) 0, 2, 4 the mean serum amylase value (U/L) was 738.1, 57.7 and 43 respectively. [Normal Range: 22 – 80U/L in our institute] As the Balthazar score (necrosis) increases, the value of serum amylase remains in the normal limits and does not increase suggesting an inverse correlation between the two.

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Correlation of Modified Computed Tomography Severity Index with Biochemical Markers in Acute Pancreatitis

Journal of Radiation and Nuclear Medicine ◽

10.14302/issn.2766-8630.jrnm-21-3713 ◽

2021 ◽

Vol 1 (2) ◽

pp. 6-12

Author(s):

Joshi BR ◽

Kumar S ◽

Khanal UP

Keyword(s):

Computed Tomography ◽

Acute Pancreatitis ◽

Multislice Computed Tomography ◽

Serum Amylase ◽

Scoring Systems ◽

Severity Index ◽

Serum Levels ◽

Index Score ◽

Severity Index Score ◽

Progression Of Disease

Introduction Multislice computed tomography examinations performed 3 to 4 days after the onset of symptoms is the imaging procedure of choice in acute pancreatitis, which is mainly done for evaluating the complications. Due to radiation exposure and cost, alternative scoring systems like Ranson’s score and Glasgow’s score were devised but were cumbersome. The serum amylase and lipase were found to increase with progression of disease. The objective of this study was to evaluate the association of acute pancreatitis by modified CT scoring system with the serum levels of amylase and lipase. Material and Methods In hundred patients presenting with acute pancreatitis, the severity of pancreatitis was recorded using the modified CT severity index. The serum amylase and lipase levels were recorded and correlated with modified CT severity index score. Results Among 100 patients studied, 46%, 40% and 14% had mild, moderate and severe grades of pancreatitis respectively by modified CTSI score. No significant correlation was found between the levels of serum amylase (r = -0.104, p = 0.301) and lipase (r = -0.177, p = 0.079) with the modified CT severity index in patients with acute pancreatitis. Conclusion The serum level of amylase and lipase had non-significant correlation with the modified CT severity index score and thus did not indicate severity of pancreatitis.

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Restoration of intestinal mucosal in Euphorbia kansui-treated severe acute pancreatitis rats is based on HMGB1/MFG-E8 expression

Current Pharmaceutical Biotechnology ◽

10.2174/1389201021666201218130440 ◽

2020 ◽

Vol 21 ◽

Author(s):

Chengjiang Qiu ◽

Kairui Liu ◽

Xuguang Li ◽

Weirun Chen ◽

Sheng Zhang ◽

...

Keyword(s):

Acute Pancreatitis ◽

Severe Acute Pancreatitis ◽

Serum Amylase ◽

Intestinal Barrier ◽

Enzyme Linked Immunosorbent Assay ◽

Inflammatory Factor ◽

Apoptotic Cells ◽

Rat Ileum ◽

Plasma Endotoxin ◽

Euphorbia Kansui

Background: The pathogenesis of severe acute pancreatitis (SAP) is mediated substantially by dysfunctions in the intestinal barrier. Euphorbia kansui (EK) is a medicinal plant used widely in traditional Chinese medicine to treat inflammation; however, its efficacy and mechanism of action in SAP treatment is not yet well understood. Objective: To investigate the role of EK in intestinal barrier tissue repair and in the pathogenesis and development of SAP. Methods: The rat SAP model was established by a retrograde injection of sodium taurocholate into the pancreatic bile duct. The SAP model group and the SAP + EK treatment groups were divided into 6 subgroups according to timing: 2, 6, 12, 24, 48, or 72 h after inducing SAP. The progression of the SAP rats and of the rats receiving the EK treatment was evaluated using the ascites volume, serum amylase and plasma endotoxin levels, and histological grading of intestinal mucosal damage. In addition, serum inflammatory factor contents were measured using enzyme-linked immunosorbent assay (ELISA) tests and apoptotic cells in damaged ileum tissue were detected using TUNEL staining. Apoptosis markers and other signaling proteins in intestinal mucosal cells were detected by immunohistochemical assays and then validated by combining these data with quantitative polymerase chain reactions and western blotting. Results: Compared with the results of the SAP model rats, the results of the rats that received EK treatment demonstrated that EK could effectively reduce the ascites volume and serum amylase and plasma endotoxin levels. EK treatment also greatly reduced the abnormal intestinal morphological alterations in the rat SAP model and significantly downregulated the serum contents of interleukin (IL)-1β, IL-6, and tumor necrosis factor-α. EK treatment inhibited the elevation of capapse-3, inhibited the decrease of the Bcl-2 protein, and decreased the number of apoptotic cells in rat ileum tissue. Finally, EK treatment abrogated the increase of HMGB1 and the suppression of MFG-E8 protein expression in the SAP + EK rat ileum tissue. Conclusion: EK suppresses SAP pathogenesis by restoring intestinal barrier function and modulating the HMGB1/MFG-E8 signaling axis.

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Haemoconcentration as a predictor of severity in acute pancreatitis

Journal of Kathmandu Medical College ◽

10.3126/jkmc.v4i1.15020 ◽

2016 ◽

Vol 4 (1) ◽

pp. 3-7

Author(s):

Tanka Prasad Bohara ◽

Dimindra Karki ◽

Anuj Parajuli ◽

Shail Rupakheti ◽

Mukund Raj Joshi

Keyword(s):

Acute Pancreatitis ◽

Pearson Correlation ◽

Characteristic Curve ◽

Scoring Systems ◽

Cost Effective ◽

Receiver Operator Characteristic Curve ◽

First Episode ◽

P Value ◽

Receiver Operator Characteristic ◽

Chi Square

Background: Acute pancreatitis is usually a mild and self-limiting disease. About 25 % of patients have severe episode with mortality up to 30%. Early identification of these patients has potential advantages of aggressive treatment at intensive care unit or transfer to higher centre. Several scoring systems are available to predict severity of acute pancreatitis but are cumbersome, take 24 to 48 hours and are dependent on tests that are not universally available. Haematocrit has been used as a predictor of severity of acute pancreatitis but some have doubted its role.Objectives: To study the significance of haematocrit in prediction of severity of acute pancreatitis.Methods: Patients admitted with first episode of acute pancreatitis from February 2014 to July 2014 were included. Haematocrit at admission and 24 hours of admission were compared with severity of acute pancreatitis. Mean, analysis of variance, chi square, pearson correlation and receiver operator characteristic curve were used for statistical analysis.Results: Thirty one patients were included in the study with 16 (51.61%) male and 15 (48.4%) female. Haematocrit at 24 hours of admission was higher in severe acute pancreatitis (P value 0.003). Both haematocrit at admission and at 24 hours had positive correlation with severity of acute pancreatitis (r: 0.387; P value 0.031 and r: 0.584; P value 0.001) respectively.Area under receiver operator characteristic curve for haematocrit at admission and 24 hours were 0.713 (P value 0.175, 95% CI 0.536 - 0.889) and 0.917 (P value 0.008, 95% CI 0.813 – 1.00) respectively.Conclusion: Haematocrit is a simple, cost effective and widely available test and can predict severity of acute pancreatitis.Journal of Kathmandu Medical College, Vol. 4(1) 2015, 3-7

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SARS-CoV-2 infection in acute pancreatitis increases disease severity and 30-day mortality: COVID PAN collaborative study

Gut ◽

10.1136/gutjnl-2020-323364 ◽

2021 ◽

pp. gutjnl-2020-323364

Author(s):

Sanjay Pandanaboyana ◽

John Moir ◽

John S Leeds ◽

Kofi Oppong ◽

Aditya Kanwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Hospital Stay ◽

Organ Failure ◽

Collaborative Study ◽

Length Of Hospital Stay ◽

Secondary Outcome ◽

Icu Admission ◽

Local Complications ◽

Persistent Organ Failure ◽

Increased Risk

ObjectiveThere is emerging evidence that the pancreas may be a target organ of SARS-CoV-2 infection. This aim of this study was to investigate the outcome of patients with acute pancreatitis (AP) and coexistent SARS-CoV-2 infection.DesignA prospective international multicentre cohort study including consecutive patients admitted with AP during the current pandemic was undertaken. Primary outcome measure was severity of AP. Secondary outcome measures were aetiology of AP, intensive care unit (ICU) admission, length of hospital stay, local complications, acute respiratory distress syndrome (ARDS), persistent organ failure and 30-day mortality. Multilevel logistic regression was used to compare the two groups.Results1777 patients with AP were included during the study period from 1 March to 23 July 2020. 149 patients (8.3%) had concomitant SARS-CoV-2 infection. Overall, SARS-CoV-2-positive patients were older male patients and more likely to develop severe AP and ARDS (p<0.001). Unadjusted analysis showed that SARS-CoV-2-positive patients with AP were more likely to require ICU admission (OR 5.21, p<0.001), local complications (OR 2.91, p<0.001), persistent organ failure (OR 7.32, p<0.001), prolonged hospital stay (OR 1.89, p<0.001) and a higher 30-day mortality (OR 6.56, p<0.001). Adjusted analysis showed length of stay (OR 1.32, p<0.001), persistent organ failure (OR 2.77, p<0.003) and 30-day mortality (OR 2.41, p<0.04) were significantly higher in SARS-CoV-2 co-infection.ConclusionPatients with AP and coexistent SARS-CoV-2 infection are at increased risk of severe AP, worse clinical outcomes, prolonged length of hospital stay and high 30-day mortality.

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