LIPASE-AMYLASE RATIO DOES NOT DETERMINE THE ETIOLOGY OF ACUTE-PANCREATITIS - ANOTHER MYTH BITES THE DUST

We examined the feasibility of the lipase-amylase (L/A) ratio to diffe rentiate alcoholic from nonalcoholic acute pancreatitis in a large pro spective series of patients with acute pancreatitis, One hundred fifty -eight consecutive patients with acute pancreatitis were studied. The pancreatitis was of biliary origin in 112 patients, due to alcohol abu se in 26, due tn other causes in 8, and of unknown origin ia 12, For a ll patients, serum, amylase, and lipase levels were determined simulta neously. and the L/A ratio was calculated using the amylase and lipase serum levels expressed as multiples of the respective upper normal li mit, The ratios in patients with alcoholic acute pancreatitis ranged f rom 0.3 to 8 and in patients with nonalcoholic acute pancreatitis from 0 to 19.9. A value of 2.2 for the serum L/A ratio was found to be the best cutoff value for differentiating alcoholic from nonalcoholic acu te pancreatitis. Using this limit, the sensitivity, specificity: and d iagnostic accuracy of tile LIA ratio in determining the alcoholic form of acute pancreatitis were 54%, 82%, and 77% respectively. Our study showed that the WA ratio is not useful in distinguishing alcoholic fro m nonalcoholic acute pancreatitis.