Is the association of serum lipase with beta(2)-microglobulin or C-reactive protein useful for establishing the diagnosis and prognosis of patients with acute pancreatitis?

In the Emergency Department it is mandatory to establish the diagnosis and the prognosis of acute pancreatitis as soon as possible. To evaluate whethe r the association of serum lipase either with serum beta(2)-microglobulin o r with C-reactive protein allows simultaneously to establish the diagnosis and the prognosis of acute pancreatitis, 96 patients with acute abdomen wer e studied. Fifty-eight patients had non-pancreatic acute abdomen and the re maining 38 had acute pancreatitis: 23 mild acute pancreatitis, and 15 sever e acute pancreatitis. Forty healthy subjects were studied as controls. Lipa se, beta(2)-microglobulin and C-reactive protein were determined in the ser um of all subjects, using commercial kits. One patient with acute pancreati tis was not correctly classified when lipase was used to discriminate betwe en patients with nonpancreatic acute abdomen and those with acute pancreati tis. For the discrimination of patients with severe acute pancreatitis from those with the mild form of the disease in the remaining 37 acute pancreat itis patients, beta(2)-microglobulin had a sensitivity of 53.3%, specificit y of 81.8%, and prognostic accuracy of 70.3% (27 of the 37 patients correct ly classified); 87.5% of the 96 cases were correctly classified. C-reactive protein showed a lower prognostic accuracy than beta(2)-microglobulin: sen sitivity 86.7%, specificity 45.5%, accuracy 62.2%; 84.4% of the cases were correctly classified. Using the polychotomous logistic regression analysis we found the same accuracy in discriminating between patients with acute pa ncreatitis and those with non-pancreatic acute abdomen (99.0%) but a lower accuracy (54.1%)between patients with severe acute pancreatitis and those w ith the mild form of the disease. Our study shows that the association of s erum lipase with beta(2)-microglobulin or with C-reactive protein is not us eful in simultaneously establishing the diagnosis and prognosis of acute pa ncreatitis.