Clinical Analysis of the Efficacy in Lipase/ Amylase Ratio for Acute Pancreatitis

The mortality rate is high in complicated pancreatitis. The serum lipase/amylase (L/A) ratio had been proposed to distinguish the etiology of pancreatitis, the efficacy to predict the severity of acute pancreatitis is assessed in this study. From July 1, 2001 to June 30, 2002, 247 patients with acute pancreatitis were enrolled. We included 141 (57.1%) men and 106(42.9%) women with a mean age of 53.6 years, ranging from 21 to 90 years. They were divided into 3 subgroups according to their attributed etiology such as alcohol (n=54), biliary (n=111), miscellaneous causes (n=82) and their serum L/A ratio level were compared. Besides, the relationship between the severities of pancreatitis by computed tomography (CT) findings and L/A ratio levels were also analyzed. Results showed that 47 patients were alcoholic acute panceatitis (21.9 %, 52 male and 2 female), 111 patients with biliary acute pancreatitis (44.9%), and 82 patients with miscellaneous acute pancreatitis (33.2%). Significant factors were: mean age 40 ± 9.4 years in alcoholic group versus 59.2 ± 14.7 years in biliary group; male predominance in alcoholic group and female dominated the biliary group; the elevation of serum amylase level in biliary group (1344.2±1453.7 IU/L) versus in alcoholic group (346.9 ± 374.9 IU/L), and serum lipase level in biliary group (13072.0±18807.9 IU/L) versus in alcohol group (3119.7 ± 4923.7 IU/L). Instead, the serum L/A ratio showed no significant changes among each group. If L/A ratio > 2, it had 89.5% negative predictive rate of alcoholic pancreatitis. In this study, the alcoholic acute pancreatitis is more severe than biliary ones. There was also no difference in serum enzyme levels (amylase, lipase, and L/A ratio) observed among patients without apparent imaging signs of acute pancreatitis, those with signs of moderate and severe pancreatitis. Therefore, we conclude that gender difference plays an important role in the etiology of acute pancreatitis. The serum amylase and lipase concentrations are not able to establish either etiology or to predict the severity of acute pancreatitis as assessed by imaging techniques. The L/A ratio is not a good predictive factor in distinguishing acute episode of alcoholic and non-alcoholic acute pancreatitis but the L/A ratio > 2 has 89.5 % of negative predictive rate for alcoholic panceatitis. ( J Intern Med Taiwan 2005; 16: 113-120 )