Clinical significance of elevated serum and urine amylase levels in patients with appendicitis

Swensson, Erik E.; Maull, Kimball I.

doi:10.1016/0002-9610(81)90308-1

Cited by 20 publications

(9 citation statements)

References 15 publications

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“…It is well-known that hyperamylasemia may be observed in acute abdominal conditions other than acute pancreatitis such as acute peritonitis, acute appendicitis, renal calculi and intestinal obstruction, and abdominal surgery. [26][27][28][29][30][31] However, this was not the case in our patients. Our data also agree with those of Vadas et al [32] who found similar data in septic shock patients by using phospholipase A2 determination.…”

Section: Discussioncontrasting

confidence: 54%

Is the pancreas affected in patients with septic shock? — a prospective study

Pezzilli

Barassi

Imbrogno

et al. 2011

Hepatobiliary & Pancreatic Diseases International

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BACKGROUND: Hyperamylasemia can be observed anecdotally during the course of severe sepsis or septic shock. This study aimed to investigate the possibility of pancreatic involvement in patients with septic shock using serum pancreatic enzyme determinations and imaging techniques in 21 consecutive patients with septic shock and 21 healthy subjects as controls. METHODS:The serum activity of pancreatic amylase and lipase was assayed initially in all subjects and 24 and 48 hours after the initial observation in the 21 patients with septic shock. All patients also underwent radiological examination to detect pancreatic abnormalities. RESULTS:The serum activity of pancreatic amylase was significantly higher in the 21 patients with septic shock than in the 21 control subjects during the study period, while the serum activity of lipase was similar to that of the control subjects. Amylase and lipase serum activity did not significantly changed throughout the study period in the 21 patients with septic shock. None of the patients with pancreatic hyperenzymemia had clinical signs or morphological alterations compatible with acute pancreatitis. CONCLUSION:The presence of pancreatic hyperenzymemia in septic shock patients is not a biochemical manifestation of acute pancreatic damage, and the management of these patients should be dependent on the clinical situation and not merely the biochemical results.

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Section: Discussioncontrasting

confidence: 54%

Is the pancreas affected in patients with septic shock? — a prospective study

Pezzilli

Barassi

Imbrogno

et al. 2011

Hepatobiliary & Pancreatic Diseases International

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“…While hyperamylasemia is often seen in various pancreatic diseases, extrapancreatic factors also result in hyperamylasemia (salivary disease, gastrointestinal disease, gynecologic disease, extra-pancreatic tumors, and others) [1-3]. Hyperamylasemia was found in 9.7% of patients with appendicitis [20], 9.3% of patients with acute cholecystitis [21], and 16.0% of patients with a perforated peptic ulcer [22]. To compensate for the incomplete diagnostic ability of sAm, other pancreatic enzymes have been proposed.…”

Section: Discussionmentioning

confidence: 99%

Urinary amylase / urinary creatinine ratio (uAm/uCr) - a less-invasive parameter for management of hyperamylasemia

et al. 2013

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BackgroundThe serum level of amylase (sAm) is commonly used as a biochemical marker for diagnosis and management of pancreatic disorders. However, the use of the urine level of amylase (uAm) is limited in practice, because the diagnostic ability of uAm is inferior to that of sAm. In the present study, the possible concordance of uAm-rerated parameters with sAm was investigated, and evaluate the usefulness of uAm for management of hyperamylasemia.MethodsFrom June 1995 to October 2009, 804 samples of both urine and blood were collected from 128 patients in order to measure the serum level of amylase (sAm) and the urine level of amylase (uAm) and creatinine (uCr). Concordance of parameters using uAm compared to sAm was assessed. Parameters used were uAm, amylase creatinine clearance ratio (ACCR), and the ratio of uAm to uCr (uAm/uCr).ResultsuAm/uCr had the best correlation with sAm (r = 0.779, p < 0.001) compared to uAm (r = 0.620, p < 0.001) and to ACCR (r = 0.374, p < 0.001), when sAm was over the standard level. The area under the receiver operating characteristic curve of uAm/uCr (0.884) was significantly higher than that of uAm (0.766) and of ACCR (0.666) (p < 0.001 for each). The cutoff value of uAm/uCr was 569.8, with a sensitivity of 81.0% and a specificity of 83.1%.ConclusionsThe uAm/uCr ratio correlated with sAm, and may be an alternative to sAm for prediction of hyperamylasemia. Use of urine samples results in a decreased need for blood sampling, which is especially beneficial in pediatric patients.

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“…14 15 In addition, serum amylase levels may be elevated in the absence of acute pancreatitis in patients with decreased glomerular filtration, in diseases of the salivary glands, and in abdominal conditions associated with inflammation, including acute appendicitis, cholecystitis, intestinal obstruction or ischaemia, peptic ulcer disease and gynaecological pathology. 16 In contrast to serum amylase, serum lipase concentration is considered a more valuable diagnostic tool, because abnormally elevated values persist for a longer duration, which is an advantage in patients with a delayed presentation. 17 In addition, serum lipase is more sensitive in terms of detecting the presence of acute alcohol-induced pancreatitis.…”

Section: Accuracy Of Amylase and Lipase Levelsmentioning

confidence: 99%

Retrospective study of patients with acute pancreatitis: is serum amylase still required?

et al. 2012

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ObjectivesTo assess the role of serum amylase and lipase in the diagnosis of acute pancreatitis. Secondary aims were to perform a cost analysis of these enzyme assays in patients admitted to the surgical admissions unit.DesignCohort study.SettingSecondary care.ParticipantsPatients admitted with pancreatitis to the acute surgical admissions unit from January to December 2010 were included in the study.MethodsData collated included demographics, laboratory results and aetiology. The cost of measuring a single enzyme assay was £0.69 and both assays were £0.99.ResultsOf the 151 patients included, 117 patients had acute pancreatitis with gallstones (n=51) as the most common cause. The majority of patients with acute pancreatitis had raised levels of both amylase and lipase. Raised lipase levels only were observed in additional 12% and 23% of patients with gallstone-induced and alcohol-induced pancreatitis, respectively. Overall, raised lipase levels were seen in between 95% and 100% of patients depending on aetiology. Sensitivity and specificity of lipase in the diagnosis of acute pancreatitis was 96.6% and 99.4%, respectively. In contrast, the sensitivity and specificity of amylase in diagnosing acute pancreatitis were 78.6% and 99.1%, respectively. Single lipase assay in all patients presenting with abdominal pain to the surgical admission unit would result in a potential saving of £893.70/year.ConclusionsDetermining serum lipase level alone is sufficient to diagnose acute pancreatitis and substantial savings can be made if measured alone.

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Clinical significance of elevated serum and urine amylase levels in patients with appendicitis

Cited by 20 publications

References 15 publications

Is the pancreas affected in patients with septic shock? — a prospective study

Is the pancreas affected in patients with septic shock? — a prospective study

Urinary amylase / urinary creatinine ratio (uAm/uCr) - a less-invasive parameter for management of hyperamylasemia

Retrospective study of patients with acute pancreatitis: is serum amylase still required?

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