caa a22 4500 445797746 CHVBK 20180317145131.0 cr unu---uuuuu 170323e20111101xx s 000 0 eng 10.1007/s10620-011-1752-5 doi (NATIONALLICENCE)springer-10.1007/s10620-011-1752-5 The Causes and Outcome of Acute Pancreatitis Associated with Serum Lipase>10,000 U/L [Elektronische Daten] [Daniel Cornett, Bret Spier, Arthur Eggert, Patrick Pfau] Objectives: Our objective was to investigate the use of serum lipase levels>10,000 U/L as a tool for predicting the etiology of acute pancreatitis (AP) and to further address the relationship between lipase elevation and disease severity. Methods: We compared patients with AP and serum lipase>10,000 U/L (HL) with patients with AP and lower serum lipase levels (855-10,000 U/L). The etiology and severity of AP were recorded. Differences between groups were calculated. Results: Of the 114 patients in the HL group, the common etiologies of AP were biliary (68%), iatrogenic trauma (14%), and idiopathic (10%). Only one patient had alcoholic AP. Conversely, the common etiologies of AP in the 146-patient comparison group (lipase 855-10,000 U/L) were broader: biliary (34%), idiopathic (23%), alcohol (14%), and iatrogenic trauma (10%). Biliary AP was twice as common in the HL group (P<0.0001) whereas alcoholic AP was significantly less common (P<0.0001). The positive predictive value (PPV) for biliary AP of lipase>10,000 U/L was 80% whereas the negative predictive (NPV) for alcoholic AP was 99%. No difference between groups was observed in the severity markers including ICU admission, length of hospital stay, complications, or mortality. Conclusions: In AP a serum lipase of>10,000 U/L at presentation is a useful marker and portends a biliary etiology while virtually excluding alcoholic AP. Therefore, if ultrasonography is negative for stones in this population, these data suggest workup with MRCP or EUS is warranted to evaluate for microlithiasis or sludge given the high likelihood of occult stone disease in these individuals. Springer Science+Business Media, LLC, 2011 Acute pancreatitis nationallicence Gallstone nationallicence Lipase nationallicence Etiology nationallicence AP : Acute pancreaitis nationallicence HL : Lipase>10,000 U/L nationallicence ERCP : Endoscopic retrograde cholangiopancreatography nationallicence CFTR : Cystic fibrosis transmembrane conductance regulator nationallicence PPV : Positive predictive value nationallicence NPV : Negative predictive value nationallicence APACHE : Acute Physiologic and Chronic Health Evaluation System nationallicence MPM : Mortality Probability Model nationallicence Cornett Daniel Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, 53705, Madison, WI, USA aut Spier Bret Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, 53705, Madison, WI, USA aut Eggert Arthur Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, 53705-2281, Madison, WI, USA aut Pfau Patrick Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, 53705, Madison, WI, USA aut Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3376-3381 0163-2116 56:11<3376 2011 56 10620 https://doi.org/10.1007/s10620-011-1752-5 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s10620-011-1752-5 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Cornett Daniel Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, 53705, Madison, WI, USA aut NATIONALLICENCE 700 1- Spier Bret Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, 53705, Madison, WI, USA aut NATIONALLICENCE 700 1- Eggert Arthur Department of Pathology and Laboratory Medicine, University of Wisconsin Hospital and Clinics, 3170 UW Medical Foundation Centennial Building (MFCB), 1685 Highland Avenue, 53705-2281, Madison, WI, USA aut NATIONALLICENCE 700 1- Pfau Patrick Division of Gastroenterology and Hepatology, University of Wisconsin Medical School, 4229 Medical Foundation Centennial Building, 1685 Highland Avenue, 53705, Madison, WI, USA aut NATIONALLICENCE 773 0- Digestive Diseases and Sciences Springer US; http://www.springer-ny.com 56/11(2011-11-01), 3376-3381 0163-2116 56:11<3376 2011 56 10620 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer