Biochemical markers of acute pancreatitis
- 1Institute of Hepatology, University College London Medical School, London, UK
- 2University Hospital Lewisham, London, UK
- Correspondence to:
Dr John O’Donohue
Gastroenterology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK; john.o’donohue{at}uhl.nhs.uk
- Accepted 31 October 2005
Abstract
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.
- 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
