From the Guidelines
Elevated lipase levels can be caused by non-pancreatic conditions such as renal disease, appendicitis, acute cholecystitis, bowel obstruction, and others, in addition to pancreatic disorders 1.
Non-Pancreatic Causes of Elevated Lipase
The causes of elevated lipase levels are not limited to pancreatic disorders. Several non-pancreatic conditions can lead to increased lipase levels, including:
- Renal disease: Impaired renal function can lead to decreased clearance of lipase, resulting in elevated levels 1.
- Appendicitis: Inflammation of the appendix can cause elevated lipase levels 1.
- Acute cholecystitis: Inflammation of the gallbladder can also lead to increased lipase levels 1.
- Bowel obstruction: Obstruction of the bowel can cause elevated lipase levels due to intestinal ischemia or inflammation 1.
- Chronic pancreatitis: Although a pancreatic disorder, chronic pancreatitis can cause persistent elevation of lipase levels 1.
Clinical Considerations
When evaluating elevated lipase levels, it is essential to consider these non-pancreatic causes, especially when clinical features do not suggest pancreatic pathology. The degree of elevation can provide clues, as non-pancreatic causes typically result in mild to moderate increases (usually less than three times the upper limit of normal), whereas pancreatic disorders often cause more significant elevations.
Diagnostic Approach
A comprehensive diagnostic approach should include a thorough medical history, physical examination, laboratory tests, and imaging studies to determine the underlying cause of elevated lipase levels. This approach will help guide treatment and management, ultimately improving patient outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Non-Pancreatic Causes of Elevated Lipase Levels
Elevated lipase levels can be caused by various non-pancreatic conditions, including:
- Renal insufficiency 2
- Non-pancreatic sources of lipolytic enzymes due to malignant tumors 2
- Acute cholecystitis 2
- Esophagitis 2
- Hypertriglyceridemia 2
- Sepsis 3
- Acute kidney injury (AKI) 3
- Ruptured ovarian cyst 4
- Other non-pancreatic diseases, such as those affecting the liver or other organs 5
Clinical Implications
It is essential to consider these non-pancreatic causes when interpreting elevated lipase levels, as they can mimic pancreatitis 2, 4. A simultaneous determination of both amylase and lipase is recommended for the evaluation of patients with abdominal pain 2. The presence of AKI or sepsis can negatively affect the diagnostic performance of lipase 3.
Laboratory Findings
The fraction of pancreatic lipase (FPL) in the total amount of serum lipase subtypes can be useful in differentiating between pancreatic and non-pancreatic lipase elevation 6. A cut-off value higher than 0.0027 for the FPL was associated with acute pancreatitis 6. However, the best discriminative cut-off value for lipase was ≥ 666 U/L, with a sensitivity of 71.4% and specificity of 88.8% 3.
Prognostic Factors
Increased neutrophil-to-lymphocyte ratio (NLR) (> 10.37), decreased albumin level, age, and presence of sepsis were independent risk factors for in-hospital mortality in non-pancreatic hyperlipasemia 3.