3 years ago

Diagnosing acute pancreatitis—Clinical and radiological characterisation of patients without threefold increase of serum lipase

Diagnosing acute pancreatitis (AP) may be challenging in patients with acute abdominal pain but missing threefold increased serum lipase levels (Lip−). This studyaims both to characterize these patients using clinical, radiological and mortality data, and to assess the group of patients who need contrast-enhanced computed tomography (CECT). Methods In this retrospective, IRB approved study 234 consecutive patients with AP were investigated. Inclusion criteria were single (SAP) and recurrent attacks (RAP) of AP and CECT ≥72h after onset of symptoms. Severity of AP was assessed by C-reactive protein at 48h after hospital admission and using 3 CT-based scores (CTSI, mCTSI, EPIC) by 2 observers. Mortality rates from pancreatic and non-pancreatic causes were noted with regard to lipase increase. Results were compared with paired t-test and Wilcoxon signed-rank test. Results 64/234 (27%) patients belonged to Lip− group and 170/234 (73%) patients were allocated to Lip+ group. Significantly more male patients (78% in Lip− vs. 63% in Lip+, p<0.05) with RAP (63% in Lip− vs. 21% in Lip+, p<0.001) were observed in the Lip− group. EPIC was significantly lower in Lip− group compared to Lip+ group (3(IQR 2–5) vs. 2(IQR 1–3), p<0.001). Mortality from pancreatic and non-pancreatic causes was comparable in Lip− and Lip+ group (pancreatic causes: 9% vs. 6%, p=0.60; nonpancreatic causes: 8% vs. 5%, p=0.58). Conclusions 27% of all patients with AP presented without threefold increase of lipase levels. Thus, they would be underdiagnosed without confirming CECT, which revealed significantly lower counts of pleural effusions and ascites. Male patients with RAP were found significantly more often among the Lip− group. Hence, they would benefit the most from CECT for diagnosing AP.

Publisher URL: www.sciencedirect.com/science

DOI: S0720048X17303583

You might also like
Never Miss Important Research

Researcher is an app designed by academics, for academics. Create a personalised feed in two minutes.
Choose from over 15,000 academics journals covering ten research areas then let Researcher deliver you papers tailored to your interests each day.

  • Download from Google Play
  • Download from App Store
  • Download from AppInChina

Researcher displays publicly available abstracts and doesn’t host any full article content. If the content is open access, we will direct clicks from the abstracts to the publisher website and display the PDF copy on our platform. Clicks to view the full text will be directed to the publisher website, where only users with subscriptions or access through their institution are able to view the full article.