From the Guidelines
The diagnosis of acute pancreatitis typically requires at least two of the following three criteria: characteristic abdominal pain, elevated pancreatic enzymes (serum amylase and/or lipase at least three times the upper limit of normal), and characteristic findings on imaging studies. For laboratory assessment, lipase is preferred over amylase due to its higher sensitivity and specificity, as indicated by the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The cut-off value of serum amylase and lipase is normally defined to be three times the upper limit, as stated in the same guidelines 1.
Diagnostic Criteria
The diagnostic criteria for acute pancreatitis include:
- Characteristic abdominal pain (severe epigastric pain often radiating to the back)
- Elevated pancreatic enzymes (serum amylase and/or lipase at least three times the upper limit of normal)
- Characteristic findings on imaging studies
Laboratory Assessment
For laboratory assessment, the following are considered:
- Lipase is preferred over amylase due to its higher sensitivity and specificity, as indicated by the 2019 WSES guidelines for the management of severe acute pancreatitis 1
- Serum triglyceride levels over 11.3 mmol/l (1000 mg/dl) indicate it as the etiology, as stated in the same guidelines 1
- Procalcitonin is the most sensitive laboratory test for detection of pancreatic infection, and low serum values appear to be strong negative predictors of infected necrosis, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1
Imaging Studies
Initial imaging often includes abdominal ultrasound to evaluate for gallstones, which are a common cause of acute pancreatitis. Contrast-enhanced CT scan is recommended for patients with uncertain diagnosis, severe symptoms, or those not improving after 48-72 hours of conservative management, as indicated by the AGA institute medical position statement on acute pancreatitis 1. CT can identify pancreatic inflammation, necrosis, and complications. MRI may be used as an alternative, particularly in patients who cannot receive CT contrast. Endoscopic ultrasound or MRCP (magnetic resonance cholangiopancreatography) may be needed to evaluate the pancreatic and biliary ducts, especially when gallstone pancreatitis is suspected but not confirmed by other imaging.
Prognostic Factors
The following are considered prognostic factors for severe acute pancreatitis:
- C-reactive Protein level ≥ 150 mg/l at third day, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1
- Hematocrit > 44% represents an independent risk factor of pancreatic necrosis, as stated in the same guidelines 1
- Urea > 20 mg/dl represents itself as an independent predictor of mortality, as stated in the same guidelines 1
From the Research
Diagnostic Criteria for Acute Pancreatitis
The diagnosis of acute pancreatitis is typically based on the presence of certain criteria, including:
- Abdominal pain consistent with acute pancreatitis 2, 3
- Elevated levels of serum amylase and/or lipase, with levels greater than three times the upper limit of normal 2, 3
- Characteristics findings seen in cross-sectional abdominal imaging, such as computed tomography (CT) scan or magnetic resonance imaging (MRI) 2, 3
Laboratory Tests
Laboratory tests used to diagnose acute pancreatitis include:
- Serum amylase and lipase analysis 4, 2, 3, 5, 6
- Lipid panel, including triglycerides 3
- Analysis of immunoglobulins 3
- Full blood count 3
- Electrolyte analysis 3
- Hemoglobin A1c test 3
- Complete metabolic panel 3
- Transabdominal ultrasound 3
Imaging Studies
Imaging studies used to diagnose acute pancreatitis include:
- Computed tomography (CT) scan 2, 3, 6
- Magnetic resonance imaging (MRI) 3
- Ultrasonography 5
- Endoscopic retrograde cholangiopancreatography (ERCP) 5, 6
Severity Assessment
Multiple criteria and scoring systems have been established for assessing the severity of acute pancreatitis, including: