Abstract

HOFMEYR, S; MEYER, C  and  WARREN, B L. Serum lipase should be the laboratory test of choice for suspected acute pancreatitis. S. Afr. j. surg. [online]. 2014, vol.52, n.3, pp.72-75. ISSN 2078-5151.  http://dx.doi.org/10.7196/sajs.2003.

BACKGROUND: Serum lipase and amylase are biochemical analyses used to establish the diagnosis of acute pancreatitis (AP). Despite lipase having been shown internationally to be a more sensitive and specific test, amylase remains a popular first-line test. OBJECTIVE: To provide a local basis for the recommendation of the best first-line laboratory test, an assessment of their performance in our local setting was undertaken. METHODS: From a prospective dataset on patients with acute abdominal pain and raised serum lipase and/or amylase values, the sensitivity and specificity of serum lipase, amylase and the two in combination was calculated for the diagnosis of AP, as defined by the Atlanta criteria. RESULTS: During the study period, 476 patients presented with acute upper or generalised abdominal pain and raised serum amylase and/or lipase values. The median age of the patients was 43 years (range 14 - 85), and 58% were men and 42% women. Of the patients, 322 (68%) presented with abdominal conditions other than AP, and 154 (32%) had AP. Ethanol abuse and gallstones accounted for 55% and 23% of cases of AP, respectively. Lipase displayed a sensitivity of 91% for AP, against 62% for amylase. Specificity was 92% for lipase and 93% for amylase. Dual testing with lipase and amylase had a sensitivity of 93%. CONCLUSIONS: Lipase is a more sensitive test than amylase when utilising cut-off levels to diagnose AP. Lipase should replace amylase as the first-line laboratory investigation for suspected AP.

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