Assays of serum lipase: analytical and clinical considerations.

1986 ◽  
Vol 32 (7) ◽  
pp. 1290-1302 ◽  
Author(s):  
J A Lott ◽  
S T Patel ◽  
A K Sawhney ◽  
S C Kazmierczak ◽  
J E Love
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Comparative Method ◽  
Analytical Sensitivity ◽  
Serum Lipase ◽  
Clinical Sensitivity ◽  
Reference Limit ◽  
Analytical Properties ◽  
Clinical Considerations ◽  
Upper Reference Limit

Abstract We evaluated three commercially available methods for determining lipase (EC 3.1.1.3) in serum--the Du Pont aca, Boehringer Mannheim Diagnostics (BMD), and Kodak Ektachem (EK) procedures--for their analytical properties and diagnostic efficiencies. Titrimetry was used as the comparative method. The BMD and EK methods showed better agreement with the titrimetric method, owing to the presence of the necessary cofactor, colipase, in their reagents. Colipase also increased the analytical sensitivity of the BMD and EK procedures as compared with the aca method. Determinations of serum lipase, by all methods, had a clinical sensitivity in excess of 80% for acute pancreatitis; the specificity of the lipase test was about 60%, or twice that of serum amylase. Serum lipase determinations with the current, simpler technology are superior to total amylase in the diagnosis of patients with acute pancreatitis. When a colipase-supplemented method is used, a serum lipase value greater than 10-fold the upper reference limit appears to be pathognomonic for acute pancreatitis or inflammation of organs close to the pancreas.

scholarly journals A comparative analysis of urine trypsinogen-2 test strip with serum lipase in diagnosis of acute pancreatitis in emergency set-up

2018 ◽  
Vol 6 (1) ◽  
pp. 252
Author(s):  
Jagmohan Mishra ◽  
Biplab Mishra ◽  
Afroza Firodous
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Acute Abdominal Pain ◽  
High Specificity ◽  
Test Strip ◽  
Confirmatory Test ◽  
Serum Lipase ◽  
Reference Limit ◽  
Set Up ◽  
Upper Reference Limit

Background: Acute pancreatitis possess difficulty in diagnosis in its emergency presentation. Hence to segregate this disease is important from other specific or non-specific causes of acute abdomen. Hence in suspected cases in majority of patients the urinary trypsinogen-2 test strip (Actim pancreatitis) can be used to detect this disease, especially in emergency set-up. The result of the strip test is then corroborated with findings of serum lipase in the blood.Methods: Author prospectively compared 205 consecutive patients with acute abdominal pain admitted to the casualty, SCB Medical College and Hospital. The patients were tested on admission with the Actim pancreatitis test strip. Serum amylase, serum lipase, and urine trypsinogen-2 concentrations were also determined quantitatively.Results: The Actim pancreatitis test strip was sensitive in 93% cases and specific in 92% cases. This was superior to that of serum lipase (sensitivity 77% and specificity 87%). With a cut-off >3x the upper reference limit, the sensitivity of serum lipase was only 52% while the specificity was 98%. The high sensitivity for the Actim pancreatitis test strip resulted in every high negative predictive value of 99%.Conclusions: In patients with acute abdominal pain seen in emergency department, a negative dipstick for urinary trypsinogen-2 rules out acute pancreatitis with high degree of probability and therefore appears to be more suitable for screening of acute pancreatitis. With its high specificity with a cut-off >3x the upper reference limit, serum lipase is suitable as a confirmatory test for pancreatitis when a positive dipstick result is obtained.

Lipase activity in serum measured with Ektachem is often increased in nonpancreatic disorders

1991 ◽  
Vol 37 (3) ◽  
pp. 447-451 ◽  
Author(s):  
Gregory A Tetrault
Keyword(s):  
Lipase Activity ◽  
Medical Records ◽  
Serum Amylase ◽  
Serum Lipase ◽  
Reference Limit ◽  
Emergency Department Patients ◽  
Upper Reference Limit ◽  
Chronic Relapsing Pancreatitis ◽  
Primary Problem ◽  
Group Serum

Abstract For patients with symptoms of pancreatitis, measurement of amylase in serum reportedly is more sensitive than that of lipase in acute pancreatitis, whereas lipase reportedly is more specific. However, serum lipase activities exceeding the upper reference limit (URL) have been reported for many patients who did not have pancreatitis. I reviewed the serum lipase and amylase concentrations of 493 consecutive inpatients and emergency department patients for whom both tests were ordered. Serum lipase and amylase activities, determined with an Ektachem 700 analyzer, were less than or equal to URL for 390 patients (83%) and greater than URL for 103. Medical records of 101 of these 103 were reviewed; 18 had acute or chronic relapsing pancreatitis. In this latter group, serum lipase values greater than URL had 100% sensitivity and 84% specificity; those of serum amylase greater than URL had 72% sensitivity and 88% specificity. However, the test combination of serum lipase greater than URL and serum amylase less than or equal to URL also occurred in 84% of the patients in which review of the medical records revealed nonpancreatic gastrointestinal or hepatobiliary disorders as the primary problem (n = 55). Therefore, serum lipase activity measured with the Ektachem assay is also often increased in patients with intra-abdominal disorders that appear to be nonpancreatic.

Neuroblastoma—When are Urinary Catecholamines and Their Metabolites ‘Normal’?

1988 ◽  
Vol 25 (6) ◽  
pp. 620-626 ◽  
Author(s):  
D J Worthington ◽  
E M Hammond ◽  
B B Eldeeb ◽  
A Green ◽  
G M Addison ◽  
...  
Keyword(s):  
Urinary Excretion ◽  
The Other ◽  
Published Data ◽  
Single Test ◽  
Creatinine Concentration ◽  
Urinary Catecholamines ◽  
Clinical Sensitivity ◽  
Reference Limit ◽  
Upper Reference Limit ◽  
The Individual

The overproduction of catecholamines and their metabolites is a well recognised feature of neuroblastoma. Published data are scarce for their urinary excretion in children with neuroblastoma and in ill children in whom this diagnosis may be considered. We have determined a graphical upper reference limit for total catecholamines, total metadrenalines and HMMA in urine, expressed as a ratio to the creatinine concentration, for a group of 174 children with neuroblastoma and 704 hospitalised children with other disorders. This graph has been determined by examining the overlap region between the results for the two groups of children and avoids the irregularities caused by statistical outliers. The sensitivity and specificity of the individual tests indicate that total catecholamines is marginally the best single test to perform when trying to diagnose neuroblastoma, with the best clinical sensitivity being achieved by examining both total catecholamines and HMMA. Only two of the 174 children with neuroblastoma would not have been detected using these two tests. Total metadrenalines did not appear to add any further information and could be dropped from the repertoire in favour of the other two measurements.

scholarly journals The role and importance of biochemical markers in diagnosis of alcoholic acute pancreatitis

2012 ◽  
Vol 65 (3-4) ◽  
pp. 152-157
Author(s):  
Snezana Tesic-Rajkovic ◽  
Biljana Radovanovic-Dinic ◽  
Tatjana Jevtovic-Stoimenov
Keyword(s):  
Acute Pancreatitis ◽  
Aspartate Aminotransferase ◽  
Alanine Aminotransferase ◽  
Biochemical Markers ◽  
Biochemical Parameters ◽  
Serum Amylase ◽  
Alcoholic Pancreatitis ◽  
Serum Lipase ◽  
Acute Alcoholic Pancreatitis ◽  
Biochemical Analyses

Introduction. Alcoholic acute pancreatitis occurs in 10% of alcoholics, who take more than 80g alcohol daily. Different biochemical markers are used to diagnose acute pancreatitis, and some of them may help in establishing etiology of acute pancreatitis. Material and Methods. This study is a prospective review of 21 patients. All patients were hospitalized at the Department for Gastroenterology and Hepatology or at the Department for Surgery of the Clinical Centre of Nis in the period from August 1st 2009 to March 1st 2010 with diagnosis of acute alcoholic pancreatitis. Detailed anamnesis, clinical examination, biochemical analyses and ultrasonography of the upper abdomen were done in all patients. All patients provided data on alcohol abuse. Results. The analysis of the corresponding biochemical parameters revealed a statistically significant correlation between the following values: serum amylase and serum lipase (R=0.964674; p<0.001), cholesterol and triglycerides (R=0.93789; p<0.001), total and direct bilirubin (R=0.857899; p<0.001) and between aspartate aminotransferase and alanine aminotransferase (R=0.824461, p<0.001) in patients with alcoholic acute pancreatitis. In addition, there was a statistically significant correlation between the values of serum amylase and urinary amylase (R=0.582742, p<0.001). Discussion. The analysis of biochemical markers showed that some of them were significant for beforehand diagnosis of alcoholic acute pancreatitis, which is in accordance with other studies. Conclusion Some biochemical parameters can be potential predictors of alcoholic acute pancreatitis (lipase/amylase ratio >2, greater ratio of aspartate aminotransferase/ alanine aminotransferase, enhanced triglycerides and values of mean corpuscular volume.

scholarly journals 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

2018 ◽  
Vol 5 (11) ◽  
pp. 3707 ◽  
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.

CAPD and Pancreatitis: No Connection

1992 ◽  
Vol 12 (3) ◽  
pp. 309-316 ◽  
Author(s):  
Amit Gupta ◽  
Zheng Vuan ◽  
Elias V. Balaskas ◽  
Ramesh Khanna ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Pancreatic Secretory Trypsin Inhibitor ◽  
Serum Lipase ◽  
High Index Of Suspicion ◽  
Acute And Chronic Pancreatitis ◽  
Symptoms And Signs ◽  
Capd Patient ◽  
Uncommon Complication

Autopsy studies have shown that approximately 56% of patients on long-term continuous ambulatory peritoneal dialysis (CAPD) develop various pancreatic abnormalities, such as acute and chronic pancreatitis, fibrosis, and acinar dilatation. This prevalence of anatomical abnormalities is similar to that observed in patients on hemodialysis and higher than that in those with normal renal function. However, clinical acute pancreatitis is an uncommon complication of CAPD (0.9%), and this prevalence is similar to that (1.7%) of patient son hemodialysis. We can attribute acute pancreatitis in CAPD patients to no single factor. Perhaps preexisting anatomical abnormalities of the pancreas make the CAPD patient susceptible to acute pancreatitis when exposed to a variety of physiological and non physiological influences. The diagnosis of acute pancreatitis in CAPD patients is difficult, because symptoms and signs are similar to those of dialysis-associated peritonitis. Serum amylase values three times greater than the upper limit of normal and effluent amylase greater than 100 U/L suggest the diagnosis of acute pancreatitis. Serum lipase, isoamylase, and pancreatic secretory trypsin inhibitor are not helpful. In confirming the diagnosis, a computed tomography (CT) scan is more helpful than ultrasound, although it is positive in only 50–60% of cases. One should harbor a high index of suspicion concerning acute pancreatitis if a CAPD patient presenting with suspected peritonitis has either a negative effluent culture or does not respond to antibiotic therapy.

scholarly journals Improved detection of minor ischemic myocardial injury with measurement of serum cardiac troponin I

1997 ◽  
Vol 43 (11) ◽  
pp. 2047-2051 ◽  
Author(s):  
Fred S Apple ◽  
Alireza Falahati ◽  
Pamela R Paulsen ◽  
Elizabeth A Miller ◽  
Scott W Sharkey
Keyword(s):  
Cardiac Troponin ◽  
Myocardial Injury ◽  
Troponin I ◽  
Cardiac Troponin I ◽  
Clinical Sensitivity ◽  
Reference Limit ◽  
Normal Limits ◽  
Serial Serum ◽  
Upper Reference Limit ◽  
Serum Cardiac Troponin

Abstract This study compared the diagnostic accuracy of the measurement of serum cardiac troponin I (cTnI) with creatine kinase (CK) MB mass in patients with minor myocardial injury whose measured total CK activity did not exceed twice the upper reference limit (300 U/L for men; 200 U/L for women). Forty-eight consecutive patients presenting with chest pain and with in-hospital documentation of myocardial injury were enrolled. Electrocardiogram, echocardiogram, and serial serum CK-MB mass, cTnI, and total CK were measured over 36 h after admission. Peak total CK activity was within normal limits in 28 patients (58%). The mean (±SD) peak CK-MB mass and cTnI concentrations were: 16.4 (11.8) μg/L and 132 (13.0) μg/L; respectively. The peak biochemical marker index (defined as CK-MB or cTnI divided by its respective upper reference limit) was significantly (P &lt;0.05) higher for cTnI than for CK-MB from 7 to 36 h. The clinical sensitivity for detection of myocardial injury for cTnI was 100% [95% confidence interval (CI): 87.2% to 100%], compared with 81.8% (CI: 67.3% to 91.8%) for CK-MB. Thus, cTnI was more sensitive than CK-MB mass for detection of myocardial injury in patients with small increases of total CK.

scholarly journals Risk Factors of Acute Pancreatitis in Oral Double Balloon Enteroscopy

2016 ◽  
Vol 59 (3) ◽  
pp. 84-90 ◽  
Author(s):  
Marcela Kopáčová ◽  
Jan Bureš ◽  
Stanislav Rejchrt ◽  
Jaroslava Vávrová ◽  
Jolana Bártová ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Double Balloon Enteroscopy ◽  
Serum Lipase ◽  
Balloon Enteroscopy ◽  
Double Balloon ◽  
Laboratory Markers ◽  
Before And After ◽  
Hs Crp ◽  
Urine Amylase

Double balloon enteroscopy (DBE) was introduced 15 years ago. The complications of diagnostic DBE are rare, acute pancreatitis is most redoubtable one (incidence about 0.3%). Hyperamylasemia after DBE seems to be a rather common condition respectively. The most probable cause seems to be a mechanical straining of the pancreas. We tried to identify patients in a higher risk of acute pancreatitis after DBE. We investigated several laboratory markers before and after DBE (serum cathepsin B, lactoferrin, E-selectin, SPINK 1, procalcitonin, S100 proteins, alfa-1-antitrypsin, hs-CRP, malondialdehyde, serum and urine amylase and serum lipase). Serum amylase and lipase rose significantly with the maximum 4 hours after DBE. Serum cathepsin and procalcitonin decreased significantly 4 hours after DBE compared to healthy controls and patients values before DBE. Either serum amylase or lipase 4 hours after DBE did not correlate with any markers before DBE. There was a trend for an association between the number of push-and-pull cycles and procalcitonin and urine amylase 4 hours after DBE; between procalcitonin and alfa-1-antitrypsin, cathepsin and hs-CRP; and between E-selectin and malondialdehyde 4 hours after DBE. We found no laboratory markers determinative in advance those patients in a higher risk of acute pancreatitis after DBE.

scholarly journals STUDY OF SERUM LIPASE TO AMYLASE RATIO IN DIFFERENTIATING BETWEEN ACUTE ALCOHOLIC AND NON-ALCOHOLIC PANCREATITIS

2020 ◽  
pp. 1-2
Author(s):  
Sudhansu Sarkar ◽  
Bala Krishna Havligi
Keyword(s):  
Acute Pancreatitis ◽  
Serum Amylase ◽  
Imaging Modality ◽  
Severe Disease ◽  
Treatment Protocol ◽  
Fold Increase ◽  
Alcoholic Pancreatitis ◽  
Serum Lipase ◽  
Gall Stones ◽  
Overall Mortality

Acute pancreatitis (AP) is a common condition involving the pancreas. The estimated incidence is about 3% of cases presenting with pain in abdomen.(4) Gall stones and alcoholism together account for 80% of acute pancreatitis.(5) Although the overall mortality rate for acute pancreatitis is 2-10% and this is primarily related to the 10-30% of patients with severe disease characterized by pancreatic and peripancreatic necrosis.(6) Diagnosis remains clinical and can be supported by 1.5 - 2 fold increase above the upper limit of normal of serum amylase and lipase.(10) Amylase and lipase levels are known to be the most important factors in determining acute pancreatitis. It is well known that these levels are usually elevated in acute pancreatitis, without regard to whether it is of biliary type or alcoholic type. Furthermore whether or not these levels can be used to discern between the two types, has been also a matter of concern. It has been reported that the lipase/amylase ratio could be a new index distinguishing two types of pancreatitis, with the critical value being 2. This report had been followed by some debate between supporters and opponents. Currently CECT is the imaging modality of choice where areas of hypo perfusion correlate with necrosis. (11) It can’t differentiate between alcoholic and non-alcoholic AP. Identification of two groups could help formulating treatment protocol for either group. The aim of the present study is to establish the utility of the ratio of the serum lipase and serum amylase, a new index distinguishing acute episode of alcoholic from non alcoholic pancreatitis.

Sign in / Sign up

Export Citation Format

Share Document