Urinary amylase levels in the diagnosis of acute pancreatitis: a prospective case control study
DOI:
https://doi.org/10.18203/2349-2902.isj20220337Keywords:
Acute pancreatitis, Serum amylase, Serum lipase, Urinary amylaseAbstract
Background: Serum amylase has a short biological half-life and returns to normal levels within short time. Thus it’s quite conflicting in the diagnosis of acute pancreatitis, particularly in patients with mild acute pancreatitis. Therefore, present study investigates the urinary amylase levels in the diagnosis of acute pancreatitis.
Methods: The present prospective study was conducted on 100 patients, 50 with acute pancreatitis and 50 normal subjects in the departments of General Surgery and our surgical hospital. All patients were examined by clinically, biochemical and radiological investigations and diagnosed acute pancreatitis. Serum amylase levels, serum lipase levels and urinary amylase levels were estimated in both groups: cases and controls. The sensitivity and specificity of serum amylase, serum lipase and urinary amylase levels were established after comparing their values in cases and controls.
Results: The preponderance of the patients was aged between 21 and 50 years. Increase the serum amylase, lipase and urinary amylase mean values of patients with acute pancreatitis were observed statistically significant (p<0.001). Serum amylase had the highest sensitivity (100%) and serum lipase had the highest specificity (96.53%). The sensitivity and specificity of urinary amylase was found to be 97.25% and 91.47% respectively. On ROC curve analysis, the area under the curve for serum amylase, serum lipase and urinary amylase was found to be 0.845, 0.945 and 0.934.
Conclusions: We conclude that urinary amylase is a convenient and a more sensitive test for diagnosis of acute pancreatitis.
References
Russell RCG, Williams NS, Bulstrode CJK. Bailey and love’s short practice of surgery. 26th edition. London: CRC press. 2013.
Fisher WE, Andersen DK, Bell RH, Saluja AK, Brunicardi FC. Pancreas. In: Brunicardi FC, Andersen DK, Timothy RB, Dunn DL, Hunter JG, Matthews JB, Pollock RE, editors. Schwartz’s Principles of Surgery. 9th ed. New York: McGraw Hill. 2010;1167-243.
Bhattacharya S. The pancreas. In: Williams NS, Bulstrode CJK, O’Connell PR, editors. Bailey and Love’s Short Practice of Surgery. 25th ed. London: Hodder Arnold. 2008;1130-53.
Gallagher SF, Jaffray CE, Murr MM. Acute pancreatitis. In: Yeo CJ, editor. Shackelford’s Surgery of the Alimentary Tract. 7th ed. Philadelphia: Saunders. 2007;1123-31.
Clavien PA, Robert J, Meyer P, Borst F, Hauser H. Acute pancreatitis and normoamylasemia. Not an uncommon combination. Arch Surg. 1989;210:614-20.
Saxon EI, Hinkley WC, Vogel WC and Zieve L. Comparative value of serum and urinary amylase in the diagnosis of acute pancreatitis. Arch Intern Med. 1957;99:607-21.
Elman R, Arnerson N, Graham EA. Value of blood amylase estimations in the diagnosis of pancreatic disease: a clinical study. Arch Surg. 1929;19:943-67.
Mitchem JB, Linehan DC. Pancreas. In: Klingensmith ME, Aziz A, Bharat A, Fox AC, Porembka MR, editors. The Washington Manual of Surgery. 6th ed. Philadelphia: Lippincott Williams & Wilkins. 2012;324-43.
John RP. Acute pancreatitis. Surg Clin North Am. 1988;68:281-99.
Chauhan PV, Patel RR. Research and Analytical Study of 50 Cases of Acute Pancreatitis. International Journal of Science and Research. 2012;475-8.
Kandasami P, Harunarashid H, Harjit K. Acute Pancreatitis in a Multi-Ethnic Population. Singapore Med J. 2002;43:284-88.
Naik N, Patel G, Parmar H. Etiology, age and sex distribution, investigations and treatment of gallstone pancreatitis. IAIM. 2016;3:46-50.
Durie P, Gaskin KJ, Geokas MC, O`Rourke M, Largman C. Plasma immunoreactive anionic pancreatic trypsin in cystic fi brosis. J Pediatr Gastroenterol Nutr. 1982;1:337-43.
Gudgeon A, Heath D, Hurley P, Jehanli A, Patel G, et al. Trypsinogen activation peptides assay in the early prediction of severity of acute pancreatitis. Lancet. 1990;335:4-8.
Terui K, Hishiki T, Saito T, Mitsunaga T, Nakata M, et al. Urinary amylase/urinary creatinine ratio a less-invasive parameter for management of hyperamylasemia. BMC Pediatrics. 2013;13:205.
Wani MD, Chalkoo M, Ahmed Z, Yousuf AM, Arafat Y. Clinical significance of Urinary Amylase in Acute Pancreatitis. Arch Surg Clin Res. 2017;1:021-31.
Kemppainen EA, Hedstrom JI, Puolakkainen PA. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. N Engl J Med. 1997;336:1788-93.
Gumaste VV, Roditis N, Mehta D, Dave PB. Serum lipase levels in nonpancreatic abdominal pain versus acute pancreatitis. Am J Gastroenterol. 1993;88:2051-5.
Kylanpaa-Back ML, Kemppainen E, Puolakkainen P. Comparison of urine trypsinogen-2 test strip with serum lipase in the diagnosis of acute pancreatitis. Hepatogastroenterology. 2002;49:1130-4.
Treacy J, Williams A, Bais R. Evaluation of amylase and lipase in the diagnosis of acute pancreatitis. ANZ J Surg. 2001;71:577-82.
