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Persistent pancreatic enzyme elevation is correlated with superinfection in acute pancreatitis with fluid

Balázs Lázár1,2, Zsolt Abonyi-Tóth3,4, Vivien Vass1

  • 1Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary.

Frontiers in Cellular and Infection Microbiology
|July 22, 2026
PubMed
Abstract

Insights

Persistent pancreatic enzyme elevation (PPEE) increases the risk of pancreatic fluid collection (PFC) superinfection and intervention needs in acute pancreatitis (AP). However, PPEE does not impact overall mortality or disease severity.

Area of Science:

  • Gastroenterology
  • Internal Medicine
  • Clinical Research

Background:

  • Superinfection of pancreatic fluid collections (PFCs) is a significant cause of morbidity and mortality in acute pancreatitis (AP).
  • Persistent Pancreatic Enzyme Elevation (PPEE) may contribute to fluid stasis and infection, but its clinical significance is not fully understood.

Purpose of the Study:

  • To investigate the clinical impact of Persistent Pancreatic Enzyme Elevation (PPEE) on pancreatic fluid collections (PFCs) in patients with acute pancreatitis (AP).
  • To determine the association between PPEE and outcomes such as PFC infection, need for intervention, mortality, and disease severity.

Main Methods:

  • Analysis of 912 patients with PFCs from a registry of 3,694 AP patients (2012-2023).
  • Patients were categorized into PPEE or normal enzyme kinetics (NEK) groups based on amylase and lipase levels.
  • Primary outcome was PFC infection rate; secondary outcomes included mortality, organ failure, ICU admission, interventions, and length of hospital stay.

Main Results:

  • Patients with PPEE were younger and had lower BMI, with higher rates of alcoholic aetiology, smoking history, and previous pancreatic disease.
  • PFC superinfection occurred more frequently in the PPEE group (25.0% vs. 16.0%).
  • PPEE was associated with an increased need for interventions but not with differences in mortality, organ failure, or length of hospitalisation.

Conclusions:

  • Persistent Pancreatic Enzyme Elevation (PPEE) is linked to a higher risk of superinfection and intervention requirements in pancreatic fluid collections (PFCs).
  • PPEE does not appear to influence the severity of acute pancreatitis (AP) or patient mortality.
  • Regular enzyme monitoring and early ductal assessment are suggested for improved patient management.
Keywords:
acute pancreatitisbiomarkers in acute pancreatitispancreatic fluid collectionpersistent pancreatic enzyme elevationrisk stratificationsuperinfection

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