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Origin, Presentation, and Clinical Course of Nonpancreatic Hyperlipasemia
Ben L Da1, Ira A Shulman, Christianne Joy Lane
1From the Departments of *Medicine, †Pathology, and ‡Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
Objective:
The diagnosis of acute pancreatitis (AP) is defined as a constellation of abnormal pancreatic enzymes, imaging, and characteristic pain. The origin and clinical significance of isolated hyperlipasemia is unclear.
Methods:
We prospectively evaluated patients with serum lipase level greater than 3 times the upper limit of normal (ULN) admitted to Los Angeles County Hospital from October 2014 to April 2015. Patients were identified by a daily laboratory query used to support an ongoing randomized trial of goal-directed therapy for AP (NCT 01761539). Nonpancreatic hyperlipasemia (NPHL) was defined as a serum lipase level greater than 3 times the ULN without characteristic pain or imaging.
Results:
Among 221 patients with lipase level greater than 3 times the ULN, 170 met criterion for AP, and 51 did not. The leading etiologies for NPHL were decompensated cirrhosis and renal failure. Patients with NPHL were significantly older and had more comorbidities and lower serum lipase levels (360 ± 36 vs 1453 ± 135 IU/L, P < 0.001). There were no differences in length of hospitalization, intensive care unit admission, or mortality.
Conclusions:
Elevated serum lipase level has many nonpancreatic origins, with liver and renal failure being the most frequent. Distinct clinical features can help to differentiate between AP and NPHL.
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