RELATION OF DIAGNOSTIC SERUM AMYLASE LEVELS TO ETIOLOGY AND SEVERITY OF ACUTE-PANCREATITIS

The sensitivity of diagnostic serum amylase (>1000 iu/l) was assessed in 417 patients with acute pancreatitis as a result of gall stones (258), alcohol (104), or miscellaneous causes (55), of whom 111 (27%) had a clinically severe attack (including 34 deaths). On hospital admission, an amylase value diagnostic of pancreatitis was found in 96.1% of all mild cases and in 87.4% of severe cases (P<0.001); at 48 hours these values were 33.3% and 48.2% respectively (p=0.026). Diagnostic amylase levels for alcoholic patients were found in 86% of mild cases on admission and in 76% of severe cases (p<0.001, compared with other groups). The diagnostic levels were also significantly lower at 24 hours for both the alcoholic and miscellaneous groups compared with the gall stone group (p<0.001). Eight of 27 (30%) patients with a serum amylase activity <1000 iu/l had pancreatic necrosis compared with 12 of the remaining 390 (3.1%) patients (P<0.001); the mortality was also significantly different (44% v 5.6% respectively, p<0.001). These data support the view that more sensitive tests for acute pancreatitis are needed for routine use especially in those whose disease has an alcoholic aetiology.