Clinical laboratory assessment of acute pancreatitis.
BACKGROUND
Several biochemical markers in blood and urine have been investigated to establish their clinical application in patients with acute pancreatitis (AP). The relevant studies are reviewed and critically appraised.


METHODS
Medline and the World Wide Web were searched and the relevant literature was classified under the following categories: (1) diagnosis of AP and (2) prediction of: a) disease severity, b) pancreatic necrosis and its secondary infection, c) organ failure and death, and d) disease etiology.


CONCLUSIONS
Serum lipase is a more reliable diagnostic marker of AP than serum amylase. Urinary strip tests for trypsinogen activation peptide (TAP) and trypsinogen-2 provide a reliable early diagnosis of AP. Useful predictors of severity may include serum procalcitonin and urinary TAP and trypsinogen-2 on admission, serum interleukins-6 and -8 and polymorphonuclear elastase at 24 h, and serum C-reactive protein (CRP) at 48 h. Other markers such as amyloid A and carboxypeptidase B activation peptide (CAPAP) need further investigation. Biochemical prediction of pancreatic necrosis requires 72 h to reach reliability and is impractical. However, the daily monitoring of serum procalcitonin provides a non-invasive detection of infected necrosis; the promising role of phospholipase A(2) in this regard requires further investigation. Early transient hypertransaminasemia reliably predicts biliary etiology, while serum carbohydrate-deficient transferrin and trypsin may predict an alcoholic etiology.
Al-Bahrani
Ahmed Z
AZ
Department of Surgery, Manchester Royal Infirmary, UK.
Ammori
Basil J
BJ
D000208:Acute Disease; D015415:Biomarkers / Q000032:analysis / Q000097:blood / Q000652:urine; D006801:Humans; D009336:Necrosis / Q000473:pathology; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000473:pathology* / Q000652:urine
D015415:Biomarkers