A COMPARISON OF LIPASE AND AMYLASE IN THE DIAGNOSIS OF ACUTE-PANCREATITIS IN PATIENTS WITH ABDOMINAL-PAIN

The clinical value of amylase and Lipase measurement for the diagnosis of acute pancreatitis was evaluated in 253 patients presenting with a cute abdominal pain. Acute pancreatitis was detected in 32 patients by computed tomography or ultrasound. In the serum samples collected on days 0-1 after the onset of symptoms, lipase was elevated in 100% and amylase in 95%. A 95% sensitivity/specificity was reached at a lipase cutoff near twofold above normal. The receiver-operating characteristi cs (ROC) showed similar curves for both enzymes, Lipase being slightly superior to amylase. The ROC curves from days 2-3 demonstrated a much lower sensitivity/specificity of both enzymes. Lipase, however, was n otably superior to amylase: at a sensitivity of 85% the specificity of lipase (amylase) was 82% (68%). In samples from days 4-5 the accuracy of the enzyme assays was even worse; at a sensitivity of 60% the spec ificity did not increase above 70%. The diagnostic value of simultaneo us measurement of amylase and lipase was tested at different cutoffs i n two groups: the OR group, in which one of the two parameters had to be elevated, and the AND group, in which both parameters had to be abo ve normal. Combination of both parameters mainly improved the specific ity of the assay (from 91 to 98% on days 2-3 and from 93 to 97% on day 4-5) but only when, in the OR group, twofold elevated amylase was com bined with lipase. We conclude that the simultaneous determination of serum Lipase and amylase marginally improved the diagnosis of acute pa ncreatitis in patients with acute abdominal pain, however, the sensiti vity of the assay with samples collected 4-5 days after onset of the d isease remained low.