Value of the P3 amylase fraction as an indicator of the long-term prognosis of acute pancreatitis.
The value of the serum P3 amylase fraction in the prediction of the course of acute pancreatitis (AP) after the initial episode was studied prospectively. Eighty-eight patients with AP were included. Amylase, lipase, trypsin and the P3 amylase fraction were measured in serum obtained at the time of discharge. Patients were followed for 60 days after discharge and divided into two groups: 75 patients who did not have complications, of whom 22.6 per cent displayed elevation of one or more pancreatic enzymes at discharge (17.3 per cent hypertrypsinaemia, 9.3 per cent hyperlipasaemia and 6.6 per cent P3 fraction); and 13 patients who had an unsatisfactory outcome (4 died, 4 developed a pseudocyst and 5 presented with recurrent pancreatitis). All of the latter group had an increase in at least one enzyme at the time of discharge (92.3 per cent P3 fraction, 69.2 per cent trypsin, 15.3 per cent lipase, and 7.6 per cent amylase). Both the persistence of the P3 fraction and hypertrypsinaemia were significantly more frequent in patients with an unfavourable outcome than in those with an uncomplicated course (P less than 0.001). On the other hand, persistent elevation of total amylase and lipase were unrelated to outcome. The hospitalization time was similar in both groups (good outcome 21.4 +/- 1.9 days, unfavourable outcome 17.3 +/- 5.3 days). It is concluded that the presence of P3 amylase fraction or hypertrypsinaemia at the time of discharge from hospital in a patient with acute pancreatitis suggests a risk of a later complication. Careful surveillance until enzyme levels become normal is urged. It is suggested that isoamylase P3 determination is the most sensitive assay to screen for the complications of acute pancreatitis.
D000208:Acute Disease; D000681:Amylases / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000201:enzymology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies
D000681:Amylases