Simultaneous serum assays of lipase and interleukin-6 for early diagnosis and prognosis of acute pancreatitis

Background: There are no systems for the rapid diagnosis and prognosis of a cute pancreatitis in the Emergency Department. Our aim was to evaluate whet her the combined use of serum lipase and interleukin-6 or serum lipase and C-reactive protein is able to simultaneously establish both the diagnosis a nd the prognosis of acute pancreatitis, Methods: Eighty patients with acute abdomen were studied on admission to th e Emergency Room. Forty patients had nonpancreatic acute abdomen, and 40 ha d acute pancreatitis (25 had mild acute pancreatitis and 15 had severe panc reatitis). Forty healthy subjects comparable for sex and age were also stud ied as controls. Lipase, interleukin-6 and C-reactive protein were determin ed on serum in all subjects. Results: Using lipase to discriminate between patients with nonpancreatic a cute abdomen and patients with acute pancreatitis (cutoff values ranging fr om 419 to 520 U/L), one patient with acute pancreatitis was not identified correctly. To discriminate between patients with severe acute pancreatitis and those with mild pancreatitis in the remaining 39 patients, interleukin- 6 (cutoff value, <3.7 mu g/L) had a sensitivity of 100% (15 of 15) and a sp ecificity of 83% (20 of 24); 75 of 80 (94%) patients were classified correc tly. C-reactive protein (cutoff values ranging from 6 to 7 mg/L) showed a l ower prognostic efficiency than interleukin-6: sensitivity of 87% (13 of 15 ) and specificity of 46% (11 of 24). Sixty-four of 80 patients (80%) were c lassified correctly. The area under the ROC curve for interleukin-6 (0.911 +/- 0.049) was significantly (P = 0.013) greater than that for C-reactive p rotein (0.685 +/- 0.090). Conclusion: The combined use of serum lipase and interleukin-6 is useful in simultaneously establishing both the diagnosis and the prognosis of acute pancreatitis. (C) 1999 American Association for Clinical Chemistry.