The causes and outcome of acute pancreatitis associated with serum lipase 10,000 u/l
| Autor: | Daniel Cornett, Bret J. Spier, Patrick R. Pfau, Arthur A. Eggert |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Physiology Population Gallstones Gastroenterology Young Adult Wisconsin Internal medicine medicine Humans Young adult Lipase education Aged Retrospective Studies Aged 80 and over education.field_of_study biology business.industry Retrospective cohort study Hepatology Middle Aged medicine.disease Occult Endocrinology Pancreatitis Etiology biology.protein Acute pancreatitis Female business |
| Zdroj: | Digestive diseases and sciences. 56(11) |
| ISSN: | 1573-2568 |
| Popis: | Our objective was to investigate the use of serum lipase levels 10,000 U/L as a tool for predicting the etiology of acute pancreatitis (AP) and to further address the relationship between lipase elevation and disease severity.We compared patients with AP and serum lipase 10,000 U/L (HL) with patients with AP and lower serum lipase levels (855-10,000 U/L). The etiology and severity of AP were recorded. Differences between groups were calculated.Of the 114 patients in the HL group, the common etiologies of AP were biliary (68%), iatrogenic trauma (14%), and idiopathic (10%). Only one patient had alcoholic AP. Conversely, the common etiologies of AP in the 146-patient comparison group (lipase 855-10,000 U/L) were broader: biliary (34%), idiopathic (23%), alcohol (14%), and iatrogenic trauma (10%). Biliary AP was twice as common in the HL group (P 0.0001) whereas alcoholic AP was significantly less common (P 0.0001). The positive predictive value (PPV) for biliary AP of lipase 10,000 U/L was 80% whereas the negative predictive (NPV) for alcoholic AP was 99%. No difference between groups was observed in the severity markers including ICU admission, length of hospital stay, complications, or mortality.In AP a serum lipase of 10,000 U/L at presentation is a useful marker and portends a biliary etiology while virtually excluding alcoholic AP. Therefore, if ultrasonography is negative for stones in this population, these data suggest workup with MRCP or EUS is warranted to evaluate for microlithiasis or sludge given the high likelihood of occult stone disease in these individuals. |
| Databáze: | OpenAIRE |
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