REVIEW

Biochemical markers of acute pancreatitis

W R Matull¹, S P Pereira¹ and J W O’Donohue²

¹ Institute of Hepatology, University College London Medical School, London, UK
² University Hospital Lewisham, London, UK

Correspondence to:
Correspondence to:
Dr John O’Donohue
Gastroenterology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK; john.o’donohue{at}uhl.nhs.uk

Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism. Urinary trypsinogen-2 is convenient, of comparable diagnostic accuracy, and provides greater (99%) negative predictive value. Early prediction of the severity of acute pancreatitis can be made by well validated scoring systems at 48 hours, but the novel serum markers procalcitonin and interleukin 6 allow earlier prediction (12 to 24 hours after admission). Serum alanine transaminase >150 IU/l and jaundice suggest a gallstone aetiology, requiring endoscopic retrograde cholangiopancreatography. For obscure aetiologies, serum calcium and triglycerides should be measured. Genetic polymorphisms may play an important role in "idiopathic" acute recurrent pancreatitis.

Abbreviations: ALT, alanine aminotransferase; APACHE-II, acute physiology and chronic health evaluation II score; CAPB, carboxypeptidase B; ERCP, endoscopic retrograde cholangiopancreatography; IL, interleukin; NPV, negative predictive value; SIRS, systemic inflammatory response syndrome; TAP, trypsinogen activated protein

Keywords: acute pancreatitis; biochemical markers

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