Biochemical markers of acute pancreatitis

Abstract

Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism. Urinary trypsinogen-2 is convenient, of comparable diagnostic accuracy, and provides greater (99%) negative predictive value. Early prediction of the severity of acute pancreatitis can be made by well validated scoring systems at 48 hours, but the novel serum markers procalcitonin and interleukin 6 allow earlier prediction (12 to 24 hours after admission). Serum alanine transaminase >150 IU/l and jaundice suggest a gallstone aetiology, requiring endoscopic retrograde cholangiopancreatography. For obscure aetiologies, serum calcium and triglycerides should be measured. Genetic polymorphisms may play an important role in "idiopathic" acute recurrent pancreatitis.

Biliary Pancreatitis : Deadly Threat to the Elderly : Is It a Real Threat ?

“…(14) There are many causes but the most important so far are considered to be gallstones and alcohol. (15)(16)(17)(18) It has been claimed that gallstone of small size up to 5mm can enter the cystic duct and can produce this lethal syndrome. (19) There is a global consensus that female are the common victims as they harbor gallstones more frequently than males and males are more frequent victims because of alcohol.…”

Review on diagnosis of acute pancreatitis

“…Elevated serum amylase can also be found in many other intrabdominal inflammatory conditions and salivary disorders and in patients having decreased renal clearance. Macroamylasemia is a condition in which amylase remains bound to immunoglobulins or polysaccharides to form large molecular weight complexes leading to raised levels of serum amylase 21 . Hypertriglyceridemia competitively interferes with amylase assay, so a false low level of serum amylase can be found in patients having hypertriglyceridemia 21 .…”

“…PMN elastase is the protease released by activated neutrophil as a first line defense following tissue injury 21 . Granulocyte infiltration and activation occur in the early phase of acute pancreatitis 30 .…”

Serum Lipase Amylase Ratio in Predicting Aetiology, Severity and Outcome of Acute Pancreatitis in a Tertiary Care Hospital

“…Serum amylase activities may be normal in 19-32% of cases at the time of hospital admission, as a result of delayed presentation or exocrine pancreatic insufficiency-for example, secondary to chronic alcohol abuse. 3 Serum amylase also may be falsely normal in hypertriglyceridemia-associated pancreatitis. 4 The sensitivity of serum lipase for the diagnosis of acute pancreatitis is similar to that of serum amylase and is between 85% and 100%.…”