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Emergency patients with mild elevations of serum lipase and acute pancreatitis
Saqer M Althunayyan1, Abdulmajed K Alali1, Laila K Alanazi1
1From the Accidents and Trauma Department (Althunayyan), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University; from the Emergency Department (Alali, Alanazi, Alkhalifah, Mashdali), Dr. Sulaiman Al-Habib Hospital Al-Ryyan; from the Emergency And Urgetn Care Department (AlAsiri), Health Holding Company; from the Department of Emergency Medicine (Malabarey) College of Medicine, King Saud University; and from the Department of Emergency Medical Services (Mobrad), Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia.
Objectives:
To estimate the incidence of AP and determine potential predictors and the outcomes. Elevated lipase level of <3 times the upper limit of normal (ULN) cause diagnostic confusion for acute pancreatitis (AP).
Methods:
A multicenter, 6-year retrospective study enrolled adult patients who were detected with lipase level of 80-240 IU/L in the Emergency Department (ED). The Revised Atlanta Classification was used to identify AP within 72 hour (hr) from the first ED visit.
Results:
Of 1082 patients, 68 (6.3%) had AP, 393 (36.3%) were hospitalized, 64 (6%) required intensive care unit admission, and 2 (0.2%) died. Most AP cases were confirmed using computed tomography CT; 47 (69.1%), followed by repeated lipase level 15 (22.1%) and ultrasound 14 (20.6%). Alcohol exhibited the highest adjusted odds ratio of predicting AP (3.9-45.6), followed by white blood cell count (1.340-6.222), male gender (1.451-4.308), and higher lipase level (1.009-1.02). Among AP cases, 11.8% required ICU admission and 1 died within 72 hr. Chronic heart disease, obesity, fever, and tachycardia were associated with these critical outcomes.
Conclusion:
Among the study sample, 6.3% were diagnosed with AP. Most of the cases confirmed by CT and alcohol was the strongest risk factor in predicting AP. A prediction score system to stratify AP risk when lipase is <3 ULN is warranted.
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