From the Guidelines
Pancreatitis should be diagnosed based on compatible clinical features and elevations in amylase or lipase levels greater than 3 times the upper limit of normal, as recommended by the most recent guidelines 1. The diagnosis of acute pancreatitis requires a combination of clinical and laboratory findings. According to 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.
Key Diagnostic Criteria
- Acute abdominal pain consistent with pancreatitis (epigastric pain often radiating to the back)
- Serum lipase or amylase levels at least three times the upper limit of normal
- Characteristic findings on imaging studies such as CT, MRI, or ultrasound ### Laboratory Parameters
- C-reactive Protein level ≥ 150 mg/l at third day can be used as a prognostic factor for severe acute pancreatitis 1
- Hematocrit > 44% represents an independent risk factor of pancreatic necrosis 1
- Urea > 20 mg/dl represents itself as an independent predictor of mortality 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 1 The diagnosis should be established within 48 hours of admission, and confirmation can be achieved by computed tomography (CT) of the abdomen using intravenous contrast enhancement, as stated in the AGA institute medical position statement on acute pancreatitis 2.
From the Research
Pancreatitis Criteria
The diagnosis of acute pancreatitis requires the presence of at least two of the three diagnostic criteria, which include:
- Characteristic abdominal pain
- Elevated serum amylase or lipase
- Radiological evidence of pancreatitis 3, 4, 5
Diagnostic Criteria
The specific criteria for diagnosis are:
- Abdominal pain radiating to the back
- Serum lipase or amylase levels three or more times the upper limit of the normal level
- Findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI) 4
- A threshold concentration 2-4 times the upper limit of normal is recommended for diagnosis 3
Laboratory Tests
Laboratory tests used in the diagnosis of acute pancreatitis include:
- Serum amylase and lipase analysis
- A lipid panel including triglycerides
- Analysis of immunoglobulins
- A full blood count
- Electrolyte analysis
- A hemoglobin A1c test
- A complete metabolic panel
- Transabdominal ultrasound 4, 5
Imaging Studies
Imaging studies used in the diagnosis of acute pancreatitis include: