From the Guidelines
Initial laboratory tests for pancreatitis should include serum lipase and amylase, with a cut-off value of three times the upper limit of normal, as well as complete blood count, comprehensive metabolic panel, triglycerides, and calcium levels, as recommended by the 2019 WSES guidelines 1. The diagnosis of acute pancreatitis is established based on compatible clinical features and elevations in amylase or lipase levels, with lipase being the most sensitive and specific test, as stated in the AGA institute medical position statement on acute pancreatitis 1. Key laboratory parameters to assess include:
- Serum amylase and lipase levels
- Complete blood count
- Comprehensive metabolic panel
- Triglycerides
- Calcium levels
- C-reactive protein level, which can be used as a prognostic factor for severe acute pancreatitis if ≥ 150 mg/l at the third day 1
- Hematocrit, with a value > 44% representing an independent risk factor for pancreatic necrosis 1
- Urea, with a value > 20 mg/dl representing an independent predictor of mortality 1 Imaging studies, such as ultrasound and computed tomography, may also be necessary to determine the etiology of acute pancreatitis and to assess for complications, as recommended by the 2019 WSES guidelines 1. Management of pancreatitis should begin with aggressive intravenous fluid resuscitation, pain control with opioid analgesics, and initial NPO status, with early enteral feeding recommended within 24-48 hours, as well as monitoring for complications and identification of the underlying cause to prevent recurrence 1.
From the Research
Initial Laboratory Tests for Pancreatitis
- Serum amylase and lipase are the primary laboratory tests used to diagnose acute pancreatitis 2, 3, 4, 5
- Serum lipase is considered a more sensitive test than serum amylase, particularly in alcohol-induced pancreatitis 3, 5
- A threshold concentration 2-4 times the upper limit of normal is recommended for diagnosis 5
- Other enzymes such as pancreatic isoamylase, immunoreactive trypsin, and elastase are not widely used due to their limited availability and lack of clear benefit over amylase and lipase 2, 5
Management of Pancreatitis
- The diagnosis of acute pancreatitis requires the presence of at least two of the three diagnostic criteria: characteristic abdominal pain, elevated serum amylase or lipase, and radiological evidence of pancreatitis 5
- Daily measurements of enzymes have no value in assessing the clinical progress of the patient or ultimate prognosis and should be discouraged 2
- New serological and urinary markers such as serum C-reactive protein and urinary trypsinogen activation peptides may be useful in predicting the severity of acute pancreatitis, but are not widely available 2
- Serum interleukins 6 and 8 may also be promising markers, but remain experimental 2
Laboratory Tests for Severity and Etiology
- No enzyme assay has a predictive role in determining the severity or etiology of acute pancreatitis 2, 3, 5
- Serum C-reactive protein at 48 hours is the best available laboratory marker of severity 2
- Urinary trypsinogen activation peptides within 12-24 hours of onset of acute pancreatitis may be able to predict the severity, but are not widely available 2