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Predicting severe acute pancreatitis in children based on serum lipase and calcium: A multicentre retrospective
Marrit J Bierma1, Michael J Coffey2, Scott Nightingale3
1Department of Paediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
Insights
Predicting severe pediatric acute pancreatitis (AP) is possible using serum lipase and calcium levels. A significant drop in serum lipase or low calcium on day 2, combined with day 1 lipase levels, improves prediction accuracy.
Area of Science:
- Pediatric Gastroenterology
- Biochemistry
- Clinical Diagnostics
Background:
- Acute pancreatitis (AP) in children can lead to severe outcomes.
- Early identification of severe AP is crucial for timely intervention.
- Predictive markers for pediatric AP severity are needed.
Purpose of the Study:
- To identify laboratory predictors of severe pediatric AP.
- To assess the performance of these predictors on day 2 (D2).
- To combine new predictors with existing ones for improved accuracy.
Main Methods:
- Retrospective review of pediatric AP cases (2000-2011) from three hospitals.
- Analysis of laboratory trends (percentage change D1-D2) and peak/trough values within 48 hours.
- Evaluation of serum lipase and calcium levels as predictors.
Main Results:
- Serum lipase ≥50% decrease on D2 predicted severe AP (sensitivity 73%, specificity 54%).
- Calcium trough ≤2.15 mmol/L within 48h was also a significant predictor (sensitivity 59%, specificity 81%).
- Combining D1 serum lipase ≥7× ULN with D2 lipase decrease or calcium trough improved specificity for severe AP prediction.
Conclusions:
- Serum lipase and calcium trends are valuable for predicting pediatric AP severity.
- Using serum lipase ≥7× ULN on D1 (high sensitivity) and combining it with D2 calcium trough ≤2.15 mmol/L (high specificity) aids in predicting severe pediatric AP.
Objective:
This study aims to identify predictors of severe paediatric AP based on laboratory trends and peak/trough values on day 2 (D2) after presentation. The performance of identified predictors was first assessed and then combined with the previously validated sensitive predictor serum lipase ≥7 times the upper limit of normal (× ULN) on day 1 (D1).
Methods:
A retrospective review of children with AP (January 2000-July 2011) was performed at three tertiary referral hospitals (two in Australia, one in the Netherlands). Trends of candidate predictors were analysed using the percentage change from D1 to D2 or peak/trough values within 48 h after presentation.
Results:
175 AP episodes (including 50 severe episodes [29%]) were identified. Serum lipase ≥50% decrease on D2 (sensitivity 73%, specificity 54%) and calcium trough ≤2.15 mmol/L within 48 h (sensitivity 59%, specificity 81%) were identified as statistically significant predictors for severe AP. By combining the newly identified predictors with the previously validated predictor serum lipase ≥7× ULN on D1 (sensitivity 82%, specificity 53%), specificity improved to predict severe AP on D2 with the addition of: (i) serum lipase ≥50% decrease (sensitivity 67%, specificity 79%), or (ii) trough calcium ≤2.15 mmol/L (sensitivity 46%, specificity 89%).
Conclusions:
Serum lipase and calcium, may be helpful in predicting severity of paediatric AP. There may be a clinical role on D1 for using serum lipase ≥7× ULN (high sensitivity), and on D2 for combining D1 serum lipase ≥7× ULN with calcium trough ≤2.15 mmol/L within 48 h (high specificity) to help predict severe paediatric AP.
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