SERUM AMYLASE AND LIPASE IN THE EVALUATION OF ACUTE ABDOMINAL PAIN

Chase CW, Barker DE, Russell WL, Burns RP. Am Surg 1996 Dec;62(12):1028-33.

BACKGROUND: The purpose of this study was to determine 1) the incidence and magnitude of elevation in admission serum amylase and lipase levels in extrapancreatic etiologies of acute abdominal pain, and 2) the test most closely associated with the diagnosis of acute pancreatitis.

METHODS: Serum amylase and lipase levels were obtained in 306 patients admitted for evaluation of acute abdominal pain. Patients were categorized by anatomic location of identified pathology. Logistic regression analysis was used to compare the enzyme levels between patient groups and to determine the correlation between elevation in serum amylase and lipase.

RESULTS: Twenty-seven (13%) of 208 patients with an extrapancreatic etiology of acute abdominal pain demonstrated an elevated admission serum amylase level with a maximum value of 385 units (U)/L (normal range 30-110 U/L). Twenty-six (12.5%) of these 208 patients had an elevated admission serum lipase value with a maximum of 3685 U/L (normal range 5-208 U/L). Of 48 patients with abdominal pain resulting from acute pancreatitis, admission serum amylase ranged from 30 to 7680 U/L and lipase ranged from 5 to 90,654 U/L. Both serum amylase and lipase elevations were positively associated with a correct diagnosis of acute pancreatitis (P < 0.001) with diagnostic efficiencies of 91 and 94 per cent, respectively. A close correlation between elevation of admission serum amylase and lipase was observed (r = 0.87) in both extrapancreatic and pancreatic disease processes. Serum amylase and lipase levels may be elevated in nonpancreatic disease processes of the abdomen. Significant elevations (greater than three times upper limit of normal) in either enzyme are uncommon in these disorders.

CONCLUSION: The strong correlation between elevations in the two serum enzymes in both pancreatic and extrapancreatic etiologies of abdominal pain makes them redundant measures. Serum lipase is a better test than serum amylase either to exclude or to support a diagnosis of acute pancreatitis.

NORMAL AMYLASE LEVELS IN THE PRESENTATION OF ACUTE PANCREATITIS

Orebaugh SL. Am J Emerg Med 1994 Jan;12(1):21-4

Recent literature suggests that serum amylase levels are not an appropriate screen for the diagnosis of acute pancreatitis because specificity and sensitivity are poor. Evidence from several studies supports the use of lipase determinations to diagnose acute pancreatitis, and recent improvements in this assay have made it more readily available to the emergency physician. This retrospective review compares the use of serum amylase to lipase levels in the diagnosis of acute pancreatitis in 52 patients who presented to the emergency department, with the hospital discharge diagnosis serving as the gold standard to which the assays were compared. Serum lipase was found to be more sensitive than serum amylase (95% vs 79%); serum amylase levels decreased to normal significantly faster than lipase levels.