Defining the diagnostic value of hyperlipasemia for acute pancreatitis in the critically ill

Cohen, Jonah; MacArthur, Kristin L.; Atsawarungruangkit, Amporn; Perillo, Michael; Martin, Camilia R.; Berzin, Tyler M.; Shapiro, Nathan I.; Sawhney, Mandeep S.; Freedman, Steven D.; Sheth, Sunil G.

doi:10.1016/j.pan.2017.02.005

Cited by 14 publications

(12 citation statements)

References 14 publications

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“…This cut-off was chosen based on the definition of clinically relevant hyperlipasemia used in previous studies in people and dogs. 5,7,8,10,30,31 For those dogs with subsequent DGGR-lipase measurements during hospitalization, the first result measured within 24 hours of admission served as baseline, and only the highest repeated measured activity was additionally included in the data analysis. A clinically relevant in-hospital increase in DGGRlipase was arbitrarily defined as a value >3× the URL and also >2× the value at admission, and dogs were thus further grouped as nonsignificant increase in lipase (NIL) group or significant increase in lipase (SIL) group (Figure 1).…”

Section: Methodsmentioning

confidence: 99%

“…2,4,5 In others, clinically irrelevant hyperenzymemia is suspected and is believed to be associated with a variety of disorders, including head injury or intracranial events, hepatobiliary disease, malignancy, diabetic ketoacidosis (DKA), bowel obstruction, perforation, or both, and renal disease. 1,3,4,[6][7][8] Some studies have reported longer hospital stays 4 or higher mortality 6 in patients with pancreatic hyperenzymemia, but others contradict these findings. 9 Given that a diagnosis of AP in both people and dogs relies largely on a combination of clinical signs, measurement of pancreatic enzymes, and diagnostic imaging, 10 distinguishing true AP from clinically irrelevant hyperenzymemia is particularly challenging in critically ill individuals in the face of comorbidities with clinical signs that may mimic AP.…”

Section: Introductionmentioning

confidence: 99%

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Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Prümmer

Howard

Grandt

et al. 2020

Veterinary Internal Medicne

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Background: Hyperlipasemia is frequent in critically ill people without evidence of acute pancreatitis (AP), and has been associated with increased morbidity and mortality. Objective: To evaluate the prevalence of hyperlipasemia at admission and development of hyperlipasemia during hospitalization in critically ill dogs, explore factors associated with hyperlipasemia, and evaluate association with outcome. Animals: Critically ill, client owned dogs (n = 1360), presented on emergency and admitted to the intensive care unit, that had 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6 0-methylresorufin) ester (DGGR) lipase activity measured within 24 hours of admission. Methods: Retrospective cross-sectional study of clinical and laboratory records. Results: The DGGR lipase activity was increased >3× the upper reference limit at admission in 216/1360 (16%) dogs, of which 70/216 (32%) had a clinical diagnosis of AP. Other primary conditions associated with hyperlipasemia were renal, endocrine, and immune-mediated diseases, and upper airway obstruction. Predictors of hyperlipasemia at admission were prior glucocorticoid administration, vomiting and abdominal pain, increased age, plasma bilirubin and creatinine concentrations, and decreased hematocrit. Of dogs with repeat measurements, 78/345 (23%) had significantly increased lipase during hospitalization, of which 13/78 (17%) had a clinical diagnosis of AP. Other primary conditions associated with in-hospital hyperlipasemia were renal and immune-mediated disorders.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Prümmer

Howard

Grandt

et al. 2020

Veterinary Internal Medicne

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“…Although the above studies seemed to verify the possibility of direct damage by SARS-CoV-2, in critically ill patients, PE elevation often occurred. The most widely accepted explanation for PE elevation with non-viral causes was pancreatic ischemia ( 15 , 35 , 36 ). When the patient had severe infection, hypoperfusion and shock, the pancreas was insufficiently perfused, which will lead to pancreatic injury.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Pancreatic Enzymes Elevation in Patients With COVID-19: A Meta-Analysis and Systematic Review

Zhou

Yang

et al. 2022

Front. Public Health

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Background:Although coronavirus disease 2019 (COVID-19) is considered to be a disease that mainly involves the respiratory system, an increasing number of studies have reported that COVID-19 patients had pancreatic enzymes (PE) elevation and even pancreatic injury. The study aims to determine the prevalence of PE elevation, and the relationship between elevated PE and prognosis in COVID-19 patients.MethodsA comprehensive literature search was conducted according to the PRISMA guideline in PubMed, Embase, Scopus, Web of Science, and Google Scholar for studies reporting PE elevation in patients with COVID-19 from 1st January 2020 to 24th November 2021.ResultsA total of 13 studies (24,353 participants) were included in our review. The pooled prevalence of PE elevation in COVID-19 patients was 24% (18%–31%), the pooled odds ratio (OR) of mortality was 2.5 (1.7–3.6), the pooled OR of ICU admission was 4.4 (2.8–6.8), and the pooled OR of kidney injury, respiratory failure and liver injury were 3.5 (1.6–7.4), 2.0 (0.5–8.7), and 2.3 (1.4–3.9) respectively. In addition, the subgroup analysis revealed that although PE elevated to > 3 × upper normal limit (ULN) was significantly related to the mortality (OR = 4.4, 2.1–9.4), it seemed that mild elevation of PE to 1–3 ULN also had a considerable risk of mortality (OR = 2.3, 1.5–3.5).ConclusionsPE elevation was a common phenomenon in patients with COVID-19, and was associated with poor clinical outcomes. However, due to the limited numbers of included studies, the result of our study still needed to be validated.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=295630, identifier: CRD42021295630.

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“…15 Moderate elevations of amylase and/or lipase occur in a wide range of non-pancreatic conditions. 16–19 Imaging is not required for diagnosis of mild AP, and is deemed unnecessary for clinical management in mild AP. The lack of a highly specific biomarkers for AP and inconsistent use or documentation of accepted biomarkers, including imaging, may lead to the over diagnosis, under diagnosis or missed diagnosis of AP and RAP.…”

Section: Diagnostic Criteria and Identification Of Complication Risksmentioning

confidence: 99%

Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis

et al. 2018

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Recurrent acute pancreatitis (RAP) is a complex clinical syndrome with significant morbidity, unpredictable outcomes and limited treatment options. The National Institute of Diabetes and Digestive and Kidney Disease sponsored a workshop on July 25, 2018 in Pittsburgh, PA to address research gaps impeding development of effective therapies for pancreatitis. The RAP working group identified challenges to clinical progress using existing definitions, risk assessment, diagnostic and severity criteria, disease trajectories, outcomes and research methods. RAP includes all the risk of acute pancreatitis (AP) and often progresses to chronic pancreatitis (CP) with variable complications of chronic pain, exocrine insufficiency, diabetes and pancreatic cancer. However, the great variability among individuals with RAP requites better precision in defining the risks, individual episodes and their frequency, pathogenic pathways and specific outcome measures for each of the systems affected by pancreatic inflammation. Because of disease complexity, few patients are similar enough for traditional studies and methods to conduct clinical trials with small sample sizes are required. The need for genetic testing, biomarker development and better imaging methods was highlighted. Adaptive and N-of-one study designs, better endpoints and outcome measures including patient reported outcomes should considered early in developing future therapeutic trial design and include all stakeholders.

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Defining the diagnostic value of hyperlipasemia for acute pancreatitis in the critically ill

Cited by 14 publications

References 14 publications

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Hyperlipasemia in critically ill dogs with and without acute pancreatitis: Prevalence, underlying diseases, predictors, and outcome

Prevalence and Outcomes of Pancreatic Enzymes Elevation in Patients With COVID-19: A Meta-Analysis and Systematic Review

Accelerating the Drug Delivery Pipeline for Acute and Chronic Pancreatitis

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