Hyperamylasemia and subclinical pancreatitis after cardiac surgery

Abstract

Hyperamylasemia after cardiac surgery is common but typically causes no clinical concern because it consists mainly of the salivary isoenzyme. In this study we evaluated the incidence, source, and time course of postoperative hyperamylasemia with special attention to the possibility of subclinical pancreatitis. In 88 patients prospectively tested for serum amylase and lipase concentrations, elastase 1 activity, and amylase isoenzyme characteristics, 57 (64%) showed hyperamylasemia during the early postoperative period. In most cases early hyperamylasemia was not of pancreatic origin, but two patients were diagnosed with subclinical pancreatitis. Among the last 23 patients, 5 of 10 patients with early hyperamylasemia exceeding 1000 IU/L showed late hyperamylasemia on the seventh postoperative day, when it represented mainly the pancreatic isoenzyme. Lipase concentrations and elastase 1 activities were elevated in these cases. Late hyperamylasemia following cardiac surgery may be of pancreatic origin and indicative of subclinical pancreatitis, even if early hyperamylasemia was of salivary origin.

A Soft Pancreatic Remnant is Associated with Increased Drain Fluid Pancreatic Amylase and Serum CRP Levels Following Pancreatoduodenectomy

“…Several authors reported that hyperamylasemia during the early days after surgery was frequently of salivary origin. [21][22][23] In this study, serum total amylase levels were significantly higher than serum pancreatic amylase levels on POD 1, 2, 5, and 7, although no significant difference existed between drainage fluid total amylase levels and drainage fluid pancreatic amylase levels. Additionally, in 36% of the patients, the serum total amylase levels were more than three times the serum pancreatic amylase levels on POD 1.…”

Gastrointestinal complications after cardiac surgery

“…A decreased rate of excretion into urine, rather than pancreatic cellular damage, has been postulated as a major cause 29 . Late hyperamylasaemia may indicate subclinical pancreatitis 30 .…”

Post‐ICU Care and Other Complications

“…301,302 Isolated hyperamylasemia in the early postoperative period is usually not associated with clinical symptoms or an elevated lipase level, and most commonly arises from a nonpancreatic source, such as the salivary glands, or results from decreased renal excretion. Lactic acidosis may result from impaired lactate metabolism rather than lactate generation from impaired tissue perfusion.…”

“…Lactic acidosis may result from impaired lactate metabolism rather than lactate generation from impaired tissue perfusion. 302 This is suggested by the presence of mild symptoms (anorexia, nausea, ileus) with elevation of serum lipase levels. K. Hyperamylasemia is noted in a substantial number (35-65%) of patients in the early postbypass period but is associated with clinical pancreatitis in only about 1-3% of patients.…”