Abstract
This retrospective study was conducted to assess the serum lipase / amylase ratio in acute pancreatitis for South Indian population attending the clinics of Gastroenterology and Emergency medicine in the last five years. One thousand one hundred and thirty two patients (768 males and 364 females) with acute pancreatitis (AP) were selected for the study. The diagnosis of AP was based on clinical evaluation, Computed Tomography (CT) findings and biochemical parameters such as serum lipase and amylase. Based on the etiology, the groups were divided into alcoholic, biliary and miscellaneous AP. Based on CT findings, groups were divided into mild, moderate and severe AP. Serum lipase, amylase and lipase / amylase ratio were calculated and statistically analyzed. Serum lipase levels in alcoholic group (3226.3 ± 1384.7) were significantly lower in comparison to biliary (6064.5 ± 1640.8) group though the levels were not significantly different from miscellaneous group (2132.3 ± 1210). Serum amylase values were significantly lower in alcoholic group (923.4 ± 557.5) in comparison to biliary (1736.2 ± 390.7) and there was significant difference between alcoholic and miscellaneous group (535.8 ± 477.6). The serum lipase / amylase ratio > 4 occurred in alcoholic group than with biliary and miscellaneous group. The sensitivity and specificity to predict alcoholic AP with lipase / amylase ratio at >4.0 was 84 % and 59 % respectively. In conclusion the serum lipase to amylase ratio greater than 3.0 could be used to differentiate but keeping the cut off at 4.0 would be of higher sensitivity without much change in specificity. The serum lipase to amylase ratio with a cut off of 3.0 or greater is not useful to differentiate the severe AP from milder AP. Hence, serum amylase and lipase are important for evaluation of pancreatitis though it is not a gold standard for the diagnosis or assessment of severity of acute pancreatitis.
Key Words: Lipase / amylase ratio, Acute pancreatitis, Alcoholic pancreatitis, Biliary pancreatitis
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References
- 1.Gumaste V.V., Dave P.B., Weismann D., Messer J. Lipase / amylase ratio: A new index that distinguishes acute episodes of alcoholic from non alcoholic acute pancreatitis. Gastroenterol. 1991;101:1361–1366. [PubMed] [Google Scholar]
- 2.Balthazar E.J. Acute Pancreatitis: Assessment of severity with clinical and CT Evaluation. Radiology. 2002;223(3):603–613. doi: 10.1148/radiol.2233010680. [DOI] [PubMed] [Google Scholar]
- 3.Chavez RG, U.S. Patent 4, 963, 479.
- 4.Neumann U, Junius M, Maier B. A sensitive colorimetric assay for the kinetic Lipase determination in serum (Boehringer Mannheim Chemicals). Abstract 13th Int. Congress for Clin Chem (ICCC), Den Haag, Netherlands, 28.6–3.7; 1987.
- 5.Bernard M., Patrick H., Martin J.M.B., Emmanuel P.P., Olivier P., Staccini P., Conio M., et al. Extensive etiological investigations in acute pancreatitis: results of one year prospective study. Eur J Gastroenterol Hepatol. 1999;11:891–896. [PubMed] [Google Scholar]
- 6.Renner I.G., Savage W.T., Pantoja J.L., Renner V.J. Death due to acute pancreatitis: Retrospective analysis of 405 autopsy cases. Dig Dis Sci. 1985;30:1005–1018. doi: 10.1007/BF01308298. [DOI] [PubMed] [Google Scholar]
- 7.Uhl W., Isenmann R., Curti G., Rainer V., Hans G.B., Markus W.B. Influence of etiology on the course and outcome of acute pancreatitis. Pancreas. 1996;13:335–343. doi: 10.1097/00006676-199611000-00002. [DOI] [PubMed] [Google Scholar]
- 8.Kuo-Chin C., Chi-Sin C., Chung-Mou K., Yi-Chun C., Seng-Kee C., King-Wah C., Chung-Huang Kuo. Clinical analysis of the efficacy in Lipase/Amylase ratio for acute pancreatitis. J Intern Med Taiwan. 2005;16:113–120. [Google Scholar]
- 9.King L.G., Seeling C.B., Ranney J.E. The Lipase to amylase ratio in acute pancreatitis. Am J Gastroenterol. 1995;90:67–69. [PubMed] [Google Scholar]
- 10.Tenner S.M., Steinber W.M. The admission serum lipase/amylase ratio differentiates alcoholic from nonalcoholic acute pancreatitis. Am J Gastroenterol. 1992;87:1755–1758. [PubMed] [Google Scholar]
- 11.TT Ranganathan: Alcohol related Harm in India — a fact sheet. Available via DIALOG. http://www.addictionindia.org/image-ttkh/alcohol-related-harm-in-india-afact-sheet.pdf.
- 12.Fan S.T., Choi T.K., Lai C.S., Wong J. Influence of age on the mortality from acute pancreatitis. Br J Surg. 1988;75:463–466. doi: 10.1002/bjs.1800750520. [DOI] [PubMed] [Google Scholar]
- 13.Murthy Naga Venkatesha PJ, Benegal Vivek and Murthy Prathima. Alcohol dependence in Indian Women: A clinical perspective. Available via DIALOG. http://www.nimhans.kar.nic.in/deaddiction/lit/female%20alcoholics.pdf.
- 14.Kazmierczak S.C., Catrou P.G., Lente F. Enzymatic markers of gallstone induced pancreatitis identified by ROC curve analysis, discriminant analysis, logistic regression, likelihood ratios, and information theory. Clin Chem. 1995;41:523–531. [PubMed] [Google Scholar]
- 15.Pacheco R.C., Oliveira L.C. Lipase / amylase ratio in biliary acute pancreatitis and alcoholic acute / acutized chronic pancreatitis. Arq Gastroenterol. 2007;44(1):35–38. doi: 10.1590/S0004-28032007000100008. [DOI] [PubMed] [Google Scholar]
- 16.Spechler S.J., Dalton J.W., Robbins A.H., Gerzof S.G., Stern J.S., Johnson W.C., Nabseth D.C., Schimmel E.M. Prevalence of normal serum amylase levels in patients with acute alcoholic pancreatitis. Dig Dis Sci. 1983;28:865–869. doi: 10.1007/BF01317034. [DOI] [PubMed] [Google Scholar]
- 17.Clavien P.A., Robert J., Meyer P., Borst F., Hauser H., Herrmann F., et al. Acute pancreatitis and normoamylasemia: Not an uncommon combination. Ann Surg. 1989;210:614–620. doi: 10.1097/00000658-198911000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Migliori M., Manca M., Santini D., Pezzilli R., Gullo L. Does acute alcoholic pancreatitis precede the chronic form or is the opposite true? A histological study. J Clin Gastroenterol. 2004;38:272–275. doi: 10.1097/00004836-200403000-00014. [DOI] [PubMed] [Google Scholar]