Prince of Wales Hospital General Surgery Journal Club

1
Prince of Wales HospitalGeneral Surgery Journal
Club

• August 1st 2005
• Matthew Magarey

2

• Should Serum Pancreatic Lipase Replace Serum
  Amylase as a Biomarker of Acute Pancreatitis?
• Smith R. C., Southwell-Keely J., Chesher D.
• ANZ J. Surg. June 2005 75 399-404

3
Amylase vs. Lipase

• Background
• Lipase may be superior to Amylase in making a
  diagnosis of acute pancreatitis
• Previously Lipase was more expensive and more
  difficult to measure
• There may not be a need for two similar tests

4
Amylase vs. Lipase

• Retrospective Study Jan 2001 - May 2003
• Comparison of all amylase and lipase measurements
  with clinical assessment and discharge diagnosis
• All elevated measurements had radiological
  investigations reviewed

5
Amylase vs. Lipase

• Acute Pancreatitis was defined as
• Patients admitted for management of acute
  pancreatitis and had CT or ultrasound changes
  consistent with acute pancreatitis

6
Amylase vs. Lipase

• Diagnostic cut-off for screening of patients in
  the Emergency Department with likelihood ratios
• Diagnostic threshold determined with sensivity
  and specificity
• Timing of elevation of enzymes

7
Amylase vs. Lipase

• 17531 blood samples from 10931 patients (8937
  patients had sample taken in ED)
• 1825 patients had elevated amylase or lipase
• 55 patient also had discharge diagnosis of
  pancreatitis
• 1880 patients had biochemical, radiological and
  clinical records scrutinised
• 320 patients with acute pancreatitis

8
Amylase vs. Lipase

• Receiver operator characteristic (ROC) curves
  created to determine diagnostic threshold

9
Amylase vs. Lipase

• Lipase Diagnostic threshold gt208 U/L
• sens 90.3 spec 93.0
• Amylase Diagnostic threshold gt114U/L
• sens 78.7 spec 92.6
• sens Plt0.05

10
Amylase vs. Lipase

• Article acknowledges that retrospective study
  does not give good uniformity
• Compared with other studies to show similar
  results
• Discussed reasons for measuring both amylase and
  lipase but discounted these

11
Amylase vs. Lipase

• Could this be used to alter practice in both
  investigating and monitoring acute pancreatitis?