title: Predicting severe acute pancreatitis in children based on serum lipase and calcium: A multicentre retrospective cohort study.
abstract: OBJECTIVE
  This study aims to identify predictors of severe paediatric AP based on laboratory trends and peak/trough values on day 2 (D2) after presentation. The performance of identified predictors was first assessed and then combined with the previously validated sensitive predictor serum lipase ≥7 times the upper limit of normal (× ULN) on day 1 (D1).
  
  
  METHODS
  A retrospective review of children with AP (January 2000-July 2011) was performed at three tertiary referral hospitals (two in Australia, one in the Netherlands). Trends of candidate predictors were analysed using the percentage change from D1 to D2 or peak/trough values within 48 h after presentation.
  
  
  RESULTS
  175 AP episodes (including 50 severe episodes [29%]) were identified. Serum lipase ≥50% decrease on D2 (sensitivity 73%, specificity 54%) and calcium trough ≤2.15 mmol/L within 48 h (sensitivity 59%, specificity 81%) were identified as statistically significant predictors for severe AP. By combining the newly identified predictors with the previously validated predictor serum lipase ≥7× ULN on D1 (sensitivity 82%, specificity 53%), specificity improved to predict severe AP on D2 with the addition of: (i) serum lipase ≥50% decrease (sensitivity 67%, specificity 79%), or (ii) trough calcium ≤2.15 mmol/L (sensitivity 46%, specificity 89%).
  
  
  CONCLUSIONS
  Serum lipase and calcium, may be helpful in predicting severity of paediatric AP. There may be a clinical role on D1 for using serum lipase ≥7× ULN (high sensitivity), and on D2 for combining D1 serum lipase ≥7× ULN with calcium trough ≤2.15 mmol/L within 48 h (high specificity) to help predict severe paediatric AP.
authors.affiliation: Department of Paediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Marrit J
authors.initials: MJ
authors.lastname: Bierma
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Coffey
authors.affiliation: Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia; Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia.
authors.forename: Scott
authors.initials: S
authors.lastname: Nightingale
authors.affiliation: Department of Paediatric Gastroenterology, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Patrick F
authors.initials: PF
authors.lastname: van Rheenen
authors.affiliation: Discipline of Paediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia; Department of Gastroenterology, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia. Electronic address: keith.ooi@unsw.edu.au.
authors.forename: Chee Y
authors.initials: CY
authors.lastname: Ooi
mesh_terms: D000293:Adolescent; D002118:Calcium / Q000097:blood*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D008049:Lipase / Q000097:blood*; D008297:Male; D015233:Models, Statistical; D019283:Pancreatitis, Acute Necrotizing / Q000097:blood* / Q000175:diagnosis* / Q000201:enzymology; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D008049:Lipase; D002118:Calcium
keywords: Calcium; Children; Gastroenterology; Lipase; Pancreatitis; Severity