From the Research
Lipase levels should be measured at the initial presentation of suspected pancreatitis and do not need to be repeated daily during hospitalization unless clinically indicated. A single lipase measurement at admission is typically sufficient for diagnosis when the value is greater than three times the upper limit of normal, combined with characteristic clinical symptoms. This approach is supported by recent evidence, including a 2020 study 1, which found that lipase was elevated 5 times higher above its respective upper reference limit than amylase at admission, and that amylase measurement was not necessary in the diagnosis and management of 88% of patients with acute pancreatitis.
Key Points to Consider
- Lipase has a higher sensitivity than amylase in diagnosing acute pancreatitis, as shown in a 2017 study 2 and a 2014 study 3.
- Lipase offers a larger diagnostic window than amylase, allowing it to be a useful diagnostic biomarker in early and late stages of acute pancreatitis 2.
- Repeated lipase testing is generally unnecessary for monitoring disease progression or response to treatment, as lipase levels do not reliably correlate with pancreatitis severity or prognosis.
- Additional lipase testing should be considered only if there is clinical deterioration or to evaluate new symptoms suggesting complications or recurrence.
Clinical Implications
- Treatment decisions should be guided by clinical assessment, vital signs, and other laboratory parameters rather than lipase trends.
- Repeated testing adds cost without changing management in most cases.
- A 1991 study 4 and a 1989 study 5 also support the use of lipase as a diagnostic biomarker for acute pancreatitis, although they are less recent and may not reflect current best practices.
Best Practice Recommendation
Lipase should be the primary enzyme measured in patients with suspected pancreatitis, as it offers higher sensitivity and a larger diagnostic window than amylase 2, 3.