Origin, Presentation, and Clinical Course of Nonpancreatic Hyperlipasemia

Da, Ben L.; Shulman, Ira A.; Lane, Christianne J.; Buxbaum, James

doi:10.1097/mpa.0000000000000561

Cited by 11 publications

(24 citation statements)

References 28 publications

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“…Pancreatic lipase is stored in the pancreas at concentrations 20,000 that of serum concentrations 8 . During pancreatitis, lipase is released in large amounts into the circulation 12 .…”

Section: Discussionmentioning

confidence: 99%

“…It is generally agreed upon that significant serum lipase elevation for a diagnosis of pancreatitis is three times the upper limit of normal 7 . Other organs can also secrete lipase such as the liver, kidney, and small intestine; although at generally lower serum concentrations than pancreatic lipase 8,9 . An elevated serum lipase may also reflect impaired clearance secondary to liver or renal failure 10 .…”

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confidence: 99%

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A comprehensive analysis of outcomes between COVID-19 patients with an elevated serum lipase compared to those with pancreatitis

Inamdar

et al. 2021

Preprint

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Background and Aims: COVID-19 patients may have asymptomatic hyperlipasemia without abdominal imaging findings or abdominal pain. In addition, primary and secondary pancreatitis have been described in COVID-19 patients. There is limited information on how the groups compare in outcomes. The aim is to compare outcomes among these groups. Methods: This is a retrospective study from 12 hospitals within one healthcare system examining outcomes between hospitalized COVID-19 patients with a lipase <3x upper limit of normal (ULN), asymptomatic hyperlipasemia (>3x ULN), secondary pancreatitis (typical respiratory COVID-19 symptoms and found to have pancreatitis), and primary pancreatitis (presenting with pancreatitis). Results: Of 11,883 patients admitted with COVID-19, 1,560 patients were included: 1,155 COVID-19 patients with a normal serum lipase (control group), 270 with an elevated lipase <3x ULN, 46 patients with asymptomatic hyperlipasemia with a lipase 3xULN, 57 patients with secondary pancreatitis, and 32 patients with primary pancreatitis. On adjusted multivariate analysis, the elevated lipase <3x ULN and asymptomatic hyperlipasemia groups had worse outcomes. The mortality was OR1.6 (95% CI 1.2-2.2) and 1.1 (95% CI 0.5-2.3), respectively. The need for mechanical ventilation was OR 2.8 (95% CI 1.2-2.1) and 2.8 (95% CI 1.5-5.2), respectively. Longer length of stay was OR 1.5 (95%CI 1.1-2.0) and 3.16 (95%CI 1.5-6.5), respectively. Conclusion: COVID-19 patients with an elevated lipase< 3x ULN and asymptomatic hyperlipasemia have generally worse outcomes than those with pancreatitis. This could be attributed to extrapancreatic causes (liver failure, renal failure, enteritis, etc), which may signify a more severe course of clinical disease. Key words: pancreas; SARS-CoV-2; pancreatitis

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“…Pancreatic lipase is stored in the pancreas at concentrations 20,000 that of serum concentrations 8 . During pancreatitis, lipase is released in large amounts into the circulation 12 .…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

A comprehensive analysis of outcomes between COVID-19 patients with an elevated serum lipase compared to those with pancreatitis

Inamdar

et al. 2021

Preprint

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“…Moderate hyperlipasemia above 80 U/L did not show any increased risk of IPMN in our study. Hyperlipasemia is known to be associated with non-pancreatic disorders such as in ammation or obstruction of biliary tract or gastrointestinal tract, and renal insu ciency [19,20]. Interestingly, more than half of the patients (54%) with moderate hyperlipasemia had some causes which can explain their increased lipase values (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Odds ratios (OR) for the prevalence of IPMN and cysts were estimated using unconditional logistic regression models with 95% con dence intervals (CI). ORs were adjusted for age groups (40-49, 50-59, 60-69, 70-79, and 80-89 years old), sex, and eGFR levels (< 45, 45-59, 60-89, and ≥ 90 mL/min/1.73 m 2 ) [18], because serum lipase values are affected by kidney function [19,20].…”

Section: Statistical Analysesmentioning

confidence: 99%

Elevated Serum Lipase Levels as a Marker of Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Cross-Sectional Study

Okada

Okada²,

Okada³

et al. 2020

Preprint

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Background: Intraductal papillary mucinous neoplasm (IPMN) is a well-established premalignant pancreatic lesion. It is known that mild hyperlipasemia, elevated serum lipase levels, is the risk of malignancy and poor prognosis in patients with IPMN. The purpose of this study is to reveal whether hyperlipasemia is useful in identifying patients with IPMN. Methods: The consecutive 91 patients aged 40-89 years who underwent magnetic resonance cholangio-pancreatography (MRCP) from 2016 to 2019 and who showed elevated serum lipase values above the reference range (>51 U/L) in one year were enrolled. Patients were categorized into three as having IPMN, other pancreatic cystic lesion, and non-cysts groups by MRCP. Results: IPMN was found in 22% and other pancreatic cystic lesion was found in 17% of patients. The prevalence of IPMN was higher in patients with mild hyperlipasemia (60-79 U/L) compared to those with borderline hyperlipasemia (<60 U/L) (36% vs. 17%; odds ratio, 5.2; 95% confidence interval, 1.2-22.4). Patients taking H2-blockers or weight loss >1kg/year also showed higher risk of IPMN (39% vs. 15% and 32% vs. 19%, respectively), and patients with both mild hyperlipasemia and taking H2-blockers showed the highest risk of IPMN compared to those with neither of them (75% vs. 13%). Conclusions: Patients with mild hyperlipasemia showed five times higher risk of having IPMN compared to those with borderline hyperlipasemia. Further investigation with MRCP should be considered for patients with mild hyperlipasemia, especially when they had episodes of epigastric discomfort or weight loss, to find high risk patients for future pancreatic carcinoma.

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“…Despite the continuous identification of novel biomarkers, serum lipase analysis is still the only serological tool with high strength of evidence according to the revised 2012 Atlanta Classification and preferred to amylase testing [10,11]. False positive lipase testing has been reported recently [12] and lipase analysis is not recommended for severity stratification [9]. Instead, C-reactive protein (CRP) and recently procalcitonin (PCT) are used for severity assessment of acute pancreatitis [10,13,14].…”

Section: Introductionmentioning

confidence: 99%

Serological diagnosis and prognosis of severe acute pancreatitis by analysis of serum glycoprotein 2

Roggenbuck

Goihl

Hanack

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Serological diagnosis and prognosis of severe acute pancreatitis by analysis of serum glycoprotein 2 DOI 10.1515/cclm-2016-0797 Received September 6, 2016 accepted October 10, 2016; previously published online November 12, 2016 Abstract Background: Glycoprotein 2 (GP2), the pancreatic major zymogen granule membrane glycoprotein, was reported to be elevated in acute pancreatitis in animal models. Methods: Enzyme-linked immunosorbent assays (ELISAs) were developed to evaluate human glycoprotein 2 isoform alpha (GP2a) and total GP2 (GP2t) as specific markers for acute pancreatitis in sera of 153 patients with acute pancreatitis, 26 with chronic pancreatitis, 125 with pancreatic neoplasms, 324 with non-pancreatic neoplasms, 109 patients with liver/biliary disease, 67 with gastrointestinal disease, and 101 healthy subjects. GP2a and GP2t levels were correlated with procalcitonin and C-reactive protein in 152 and 146 follow-up samples of acute pancreatitis patients, respectively.

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Origin, Presentation, and Clinical Course of Nonpancreatic Hyperlipasemia

Abstract: Elevated serum lipase level has many nonpancreatic origins, with liver and renal failure being the most frequent. Distinct clinical features can help to differentiate between AP and NPHL.

Cited by 11 publications

References 28 publications

A comprehensive analysis of outcomes between COVID-19 patients with an elevated serum lipase compared to those with pancreatitis

A comprehensive analysis of outcomes between COVID-19 patients with an elevated serum lipase compared to those with pancreatitis

Elevated Serum Lipase Levels as a Marker of Intraductal Papillary Mucinous Neoplasm of the Pancreas: A Cross-Sectional Study

Serological diagnosis and prognosis of severe acute pancreatitis by analysis of serum glycoprotein 2

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