(452) The Prognostic Value of Lipase in Predicting Morbidity and Mortality in Acute Pancreatitis

Introduction: A lipase level of more than 3 times the upper limit of normal (ULN) is used to diagnose acute pancreatitis. Although the CT severity index, the BISAP, Ranson’s, and APACHE scoring systems are known tools used to predict severity and outcomes, the prognostic value of lipase levels has been largely unexplored in adult populations.

Methods: A retrospective cohort was done involving 96 patients (47 females and 49 males) admitted for acute pancreatitis over a period of six months. The predominant ethnicity was African American (85% of the population). The patients were divided into two groups: those with lipase levels of less than 581 mg/dL (seven times the ULN) and those with lipase levels of 581 mg/dL or above. Bivariate analysis was done for the outcomes of interest between these groups. Pearson’s Chi-squared test was used to determine the correlation of the lipase levels to outcomes relating to morbidity and mortality.

Results: Statistical analysis showed that a lipase level of more than 581 mg/dL is associated with increased ICU admissions (p < 0.001), complications requiring inpatient surgery (p < 0.001), 30- day readmission (p < 0.001), and length of hospital stay (p= 0.004). There were no significant differences between the two groups in terms of 7-day readmission rates (p= 0.161), or death (p= 0.324). The odds of being admitted to ICU with lipase levels >581 mg/dL is 54 times higher (p=0.001).

Conclusions: In adult patients admitted for acute pancreatitis, a lipase level of more than 7 times the ULN is a significant predictor of increased morbidity, including increased risks for ICU admission, 30-day readmission, complications requiring surgery, and increased length of hospital stay. Although the Ranson’s scoring system is the most widely used prognostic tool to predict negative outcomes, it requires repeat laboratory workups at the 48th hour from presentation, which is impractical, as significant deterioration or recovery may have already occurred. The BISAP score is less accurate, and the CT severity index requires imaging capabilities. As all patients with acute pancreatitis will require a lipase level and the test is easily accessible, further investigation is strongly recommended regarding the prognostic utility of lipase in stratifying patients early to the appropriate level of care.