Association Between the Pancreatic Enzyme Level and Organ Failure in Trauma Patients

Abstract

BackgroundThe literature suggests an association of pancreatic enzymes with systemic inflammation resulting in secondary organ injury and dysfunction following trauma. Elevation in serum enzymes may not always be predictive of pancreatic disease, and can reflect extra pancreatic production.ObjectivesThis study was conducted to evaluate the rise in serum pancreatic enzyme levels with the incidence of organ failure following trauma.Patients and MethodsA retrospective review was performed on critically injured patients from December 2009 to March 2010. Patient’s clinical demographics, routine laboratory investigations along with amylase and lipase levels were also extracted from the patients' records. Patients with pancreatic or duodenal injuries were excluded from the study.ResultsFrom a total of 296 patients (mean age, 31 years), 85% were males. Blunt injury was seen in 91.6% of the cases and 8.4% had penetrating injury. One hundred and fifty-three patients had single organ failure, 96 had multiple organ failure and 47 had no organ failure. There was a significant difference in lipase levels (P = 0.04), potassium levels (P = 0.05) and hemoglobin levels (P = -0.004), among the three patient groups. There was no significant difference in amylase levels among the three patient groups. The observed independent predictors of mortality included coagulopathy (OR = 1.7), Glasgow coma scale (OR = 1.1, 4.7), pulmonary failure (OR = 0.0004), hepatic failure (OR = 0.048), renal failure (OR = 5.5), organ failure (OR =149.8), lipase levels (OR = 1.3), and infection (OR = 3.0).ConclusionsThere was a significant correlation between elevated lipase levels and the incidence of multiple organ failure. Moreover, No significant association was found between the elevated amylase levels and organ failure. However, on admission, measurement of these enzymes coupled with routine laboratory investigations can be a powerful tool in the early detection of patients progressing towards organ failure.

Extra Pancreatic Necrotic Volume: Can It Prognosticate Acute Necrotising Pancreatitis— A Prospective Study

“…This is to state that follow up of serum amylase cannot be used as a predictor for volume of extra-pancreatic necrosis and indirectly, organ failure. The results were similar to the study done by Subramanian et al 17 In their study also, they found no significant correlation between the amylase level and organ failure. There was a significant relationship between the increase in duration of the hospital stay and increased EPN volume in our study.…”

Factors associated with increased pancreatic enzymes in septic patients: a prospective study

“…However, the ICU length of stay and the duration of mechanical ventilation were significantly higher in patients with increased pancreatic enzymes. Similarly, Subramanian et al [ 14 ] reported that the level of serum lipase was positively correlated with the incidence of organ failure in critically ill trauma patients. In patients with septic shock, Pizzelli et al [ 15 ] reported that all the 21 included patients had increased pancreatic enzymes but none of them had clinical or radiological abnormalities suggesting acute pancreatitis.…”

“…Mechanical ventilation was started on admission to the ICU in 32 patients (64%). Median duration of mechanical ventilation was 5 [ 2 – 14 ] days. All of our patients were started on enteral feeding within the first 24 h of admission and none of them received parenteral nutrition.…”

“…Previous studies have reported that the incidence of exocrine pancreatic dysfunction in critically ill patients ranges between 14 and 80% [ 6 , 11 , 12 ]. This wide range is due to the underlying diseases as the highest levels were recorded in surgical and trauma patients [ 13 , 14 ]. However, epidemiological data regarding pancreatic dysfunction in patients with septic shock are lacking.…”

Adipose saturation reduces lipotoxic systemic inflammation and explains the obesity paradox

“…Clues to the role of adipose composition in severity come from studies from Western populations showing a BMI of >30 mostly, but not always (2, 3) associated with severity, while in Eastern populations, much lower BMIs, sometimes ≥23 (8,9), are associated with severity. This "obesity paradox" (10) also occurs in other acute scenarios such as burns (11), acute heart failure (12), after trauma (13), cardiovascular surgery (14), and during critical illnesses (15) in which elevated pancreatic enzymes (16)(17)(18) and long-chain NEFA (19,20) have been associated with severity. More recent studies associate such an enzyme leak (21) and dietary fat composition (22), along with elevated NEFA levels, to the severity (23) and mortality from coronavirus disease 2019 (COVID-19) (22,24).…”