SERUM PHOSPHOLIPASE A(2), AMYLASE, LIPASE, AND URINARY AMYLASE ACTIVITIES IN RELATION TO THE SEVERITY OF ACUTE-PANCREATITIS

Objective: To compare serum phospholipase A(2) activity with measureme nts of conventional enzymes as an indicator of the severity of acute p ancreatitis. Design: Prospective study. Setting: University hospital, Finland. Subjects: 80 Consecutive patients with acute pancreatitis. In terventions: Serum and urine samples were taken daily for a week after admission. Main outcome measures: Serum phospholipase A(2), amylase, lipase, and urinary amylase activities. Results: On admission, the ser um amylase and lipase activities increased in parallel in all patients . However, the mean serum phospholipase A(2) activity was three times higher in the patients with acute fulminant pancreatitis than in those with milder disease. The phospholipase A(2) activity remained high du ring the course of the severe disease, whereas the other enzyme activi ties decreased appreciably during the first week. In contrast to the o ther enzyme activities that of serum phospholipase A(2) correlated wel l with the severity of the acute pancreacitis. Heating at 60 degrees C for 45 minutes to inactivate the non-pancreatic thermolabile phosphol ipase A(2) reduced the total serum phospholipase A(2) activity more th an the enzyme activity in the homogenates of pancreatic tissue, which suggests that extrapancreatic phospholipase A(2) is present in serum. The receiver operating characteristic (ROC) curves confirmed the high sensitivity and specificity of serum phospholipase A(2) activity with a mean (SEM) area under the curve up to 0.870 (0.062) compared with th e other enzyme activities of which the highest area under the curve wa s 0.52 (0.089). Conclusions: In contrast to amylase and lipase activit ies, measurement of serum phospholipase A(2) activity is important in the assessment of the severity of acute pancreatitis so that optimal t reatment may be given.