Laboratory’s Role in Diagnosis and Management of Acute Pancreatitis
The incidence of acute pancreatitis is increasing in the United States. Pancreatitis is now one of the most common causes of hospitalization with a gastrointestinal disorder. Gallstones are the most common cause of pancreatitis, followed by prolonged use of alcohol. Drugs cause less than 5% of all cases of acute pancreatitis. The drugs most strongly associated with pancreatitis are azathioprine, 6-mercaptopurine, didanosine, valproic acid, angiotensin converting enzyme inhibitors, and mesalamine.
Mutations in several different genes are associated with acute and chronic pancreatitis including mutations in the genes for cationic trypsinogen (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator (CFTR), chymotrypsin C, calcium-sensing receptor, and claudin-2. These mutations probably work synergistically with other etiologies such as alcohol abuse.
Often times, the cause of acute pancreatitis cannot be established. A number of potential factors might contribute to unexplained pancreatitis, including unidentified genetic polymorphisms and exposure to smoking and other environmental toxins. Coexisting diseases such as morbid obesity and diabetes also increase the risk of acute pancreatitis, chronic pancreatitis and pancreatic cancer.
Accurate diagnosis of acute pancreatitis requires at least two of the following three diagnostic features; abdominal pain consistent with acute pancreatitis, serum lipase or amylase levels that are at least 3 times the upper limit of the normal range, and findings of acute pancreatitis on computed tomography or magnetic resonance imaging.
Approximately 80% of patients admitted with acute pancreatitis have mild, self-limited disease and are discharged within several days. Clinical factors that increase the risk of complications or death include age 60 years or older, numerous and severe coexisting conditions, body-mass index greater than 30, and long-term, heavy alcohol use. Some laboratory parameters are also predictive of severe disease, especially those that indicate intravascular volume depletion due to third-space loses. The most useful predictors are elevated blood urea nitrogen and creatinine levels and an elevated hematocrit, especially if they do not return to the normal range with fluid resuscitation. Interestingly, the degree of elevation of the serum amylase or lipase level has no prognostic value.
- Chris E. Forsmark, Santhi Swaroop Vege, and C. Mel Wilcox, Acute Pancreatitis. N Engl J Med 2016; 375:1972-1981.
- Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol 2013;108:1400-1415
- Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology 2013;13:Suppl 2:e1-15
