Serial lipase for pancreatitis: not enough evidence

Pathmarajah, Tishanthan; Idrees, Marwan; Nasim, Sana; Weber, Dieter

doi:10.1111/ans.14312

Cited by 3 publications

(3 citation statements)

References 37 publications

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“…An important feature of the case was the direct correlation between serum pancreatic enzyme levels and regression of the panniculitis (see figure 5). Serial lipase and amylase levels were not initially part of the management plan, a conscious decision by the treating team guided by the paucity of evidence for serial testing of pancreatic enzymes in the management of pancreatitis—an unnecessary cost to the healthcare system with no appreciable impact on prognosis or outcome 13 14. However, for patients presenting with pancreatic panniculitis, serial testing of serum pancreatic enzymes appears useful in identifying potential drivers behind the ongoing panniculitis—levels which in this case remained elevated despite 2 weeks of standard acute pancreatitis management and both clinical and radiological resolution of the pancreatitis.…”

Section: Discussionmentioning

confidence: 95%

Serial lipase measurements in pancreatic panniculitis

El Brihi,

Chee

2023

BMJ Case Rep

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Pancreatic panniculitis is a rare cutaneous manifestation of pancreatic disease with only scant case reports available to guide management. In this report, a woman in her 60s developed a painful, erythematous and indurated, nodular rash after an episode of acute pancreatitis postendoscopic retrograde cholangiopancreatography (ERCP). While clinically and radiologically the pancreatitis improved with standard conservative management, the panniculitis remained severely debilitating. Repeat testing of serum pancreatic enzymes revealed persistent and marked elevation. Octreotide was started to inhibit pancreatic enzyme release, and the lesions improved, with resolution of the panniculitis correlating with falling serum pancreatic enzyme levels. Hence, serial pancreatic enzyme testing may have utility in monitoring and management of pancreatic panniculitis.

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Section: Discussionmentioning

confidence: 95%

Serial lipase measurements in pancreatic panniculitis

El Brihi,

Chee

2023

BMJ Case Rep

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“…It has been reported that ANC and its complications account for 70–86% of mortality of patients with pancreatitis, and the prognosis is very poor [20]. Some studies have reported that ANC can cause severe inflammatory reactions around the pancreas, resulting in morphological and functional damage to the pancreas, decreased levels of secreted pancreatic enzymes, and poor digestion of lipids, which may be one of the reasons for RAP [21]. In addition, the long-term inflammatory reaction can cause pancreatic necrosis, which is not accurately identified by CT in the early stage, resulting in rapid recurrence after conservative treatment [22,23].…”

Section: Discussionmentioning

confidence: 99%

Prediction and evaluation of a nomogram model for recurrent acute pancreatitis

Chen,

Huang,

Luo

et al. 2024

European Journal of Gastroenterology &Amp; Hepatology

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Objective The purpose of this study was to investigate the influencing factors for recurrent acute pancreatitis and construct the nomogram model to predict the risk of recurrent acute pancreatitis. Methods Patients diagnosed with acute pancreatitis in the Affiliated Hospital of Southwest Medical University were enrolled. We collected these patients’ basic information, laboratory data, imaging information. Using Logistic regression and least absolute shrinkage and selection operator regression to select risk factor for Cross-Validation Criterion. To create nomogram and validated by receiver operator characteristic curve, calibration curves and decision curve analysis. Results A total of 533 patients with acute pancreatitis were included, including 99 recurrent acute pancreatitis patients. The average age of recurrent acute pancreatitis patients was 49.69 years old, and 67.7% of them were male. At the same time, in all recurrent acute pancreatitis patients, hypertriglyceridemic pancreatitis is the most important reason (54.5%). Regression analysis and least absolute shrinkage and selection operator regression showed that smoking history, acute necrotic collection, triglyceride, and alcohol etiology for acute pancreatitis were identified and entered into the nomogram. The area under the receiver operator characteristic curve of the training set was 0.747. The calibration curve showed the consistency between the nomogram model and the actual probability. Conclusion In conclusion, some high-risk factors like smoking history, acute necrotic collection, triglyceride, and alcohol etiology for acute pancreatitis may predict recurrent pancreatitis and their incorporation into a nomogram has high accuracy in predicting recurrence.

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“…8 The evidence for utilizing lipase as a prognostic marker is weak, and far stronger risk-stratifi cation tools exist. [7][8][9] ■ SYMPTOMS AND CLINICAL CRITERIA SHOULD GUIDE MANAGEMENT Symptom-guided and clinical criteria-guided management are the standard of care in acute pancreatitis to facilitate clinical decisions. The use of lipase, a diagnostic test, should not supersede clinical judgment.…”

Section: Qmentioning

confidence: 99%