Award: Presidential Poster Award
Samit K Datta, MD1, Anupama Inaganti, MD1, Michael T. Nguyen, BA2, Maharaj Singh, PhD3, Aboud Affi, MD1
1Aurora Health Care, Milwaukee, WI; 2University of Wisconsin School of Medicine & Public Health, Madison, WI; 3Aurora Research Institute, Milwaukee, WI
Introduction: Lipase has historically been used to diagnose acute pancreatitis. Its role in prognostication and determining illness severity has been poorly elucidated. A recent literature review demonstrated an inconclusive role of serial lipase in managing acute pancreatitis. Our aim was to evaluate the frequency of repeat lipase and its effect on outcomes.
Methods: Retrospective chart review on patients admitted to 3 facilities with a new diagnosis of acute pancreatitis between 2016-2018. Patients (age > 18) who presented with epigastric pain and lipase levels > 1179 (3x ULN) were included. Those with an unclear admission diagnosis or prior pancreatitis were excluded. Data collected included baseline characteristics, admission and any repeat lipase values, admission SIRS and BUN, cause of pancreatitis, length of stay (LOS), and mortality. Statistical analysis was performed using SAS Institute Statistical Analysis Program Version 9.4.
Results: 203 patients met inclusion criteria. There were statistically significant differences in sex and pancreatitis etiology (Table 1). Baseline lipase was not significantly different between the repeat lipase group (RLG) and the non-repeat lipase group (NRLG) (13268.7 vs 7472.8, p = 0.059) (Table 1). LOS was significantly different (5.35 d in RLG vs 2.72 d in NRLG, p = 0.001) (Table 1). There was no difference in mortality (1.8% in RLG vs 0.0% in NRLG, p = 0.450). When done, lipase was repeated an average of 2.88 times and it dropped to < 3x ULN in 81.2% of patients (Table 2). Lipase was repeated in 63.6% of patients after lipase to < 3x ULN. There was no difference in LOS (5.57 d if lipase < 3x ULN vs 4.22 d if lipase not < 3x ULN on repeat, p = 0.095) and lipase trended down in 98.8% of patients (Table 2).
Discussion: Our study demonstrates a frequent remeasurement of lipase levels for first acute pancreatitis episodes. Patients who did not have their lipase repeated had a statistically significant shorter LOS. Age, SIRS, and BUN were used as surrogate markers of severity (BISAP unable to be calculated) and there were no statistically significant differences. Lipase trend unlikely affected discharge as there was no difference in LOS in patients whose lipase went to < 3x ULN. Lipase was repeated even after returning to < 3x ULN, suggesting overuse of repeat lipase. There was no difference in mortality. Therefore, our study suggests that repeat lipase does not affect patient discharge and is being overutilized.
Citation: Samit K Datta, MD; Anupama Inaganti, MD; Michael T. Nguyen, BA; Maharaj Singh, PhD; Aboud Affi, MD. P0909 - AN OVERUSED LAB TEST? EVALUATING REPEAT LIPASE IN THE MANAGEMENT OF ACUTE PANCREATITIS AND ITS IMPACT ON PATIENT OUTCOMES. Program No. P0909. ACG 2019 Annual Scientific Meeting Abstracts. San Antonio, Texas: American College of Gastroenterology.