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Biochemical markers of acute pancreatitis
  1. W R Matull1,
  2. S P Pereira1,
  3. J W O’Donohue2
  1. 1Institute of Hepatology, University College London Medical School, London, UK
  2. 2University Hospital Lewisham, London, UK
  1. Correspondence to:
    Dr John O’Donohue
    Gastroenterology, University Hospital Lewisham, Lewisham High Street, London SE13 6LH, UK; john.o’donohue{at}


Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism. Urinary trypsinogen-2 is convenient, of comparable diagnostic accuracy, and provides greater (99%) negative predictive value. Early prediction of the severity of acute pancreatitis can be made by well validated scoring systems at 48 hours, but the novel serum markers procalcitonin and interleukin 6 allow earlier prediction (12 to 24 hours after admission). Serum alanine transaminase >150 IU/l and jaundice suggest a gallstone aetiology, requiring endoscopic retrograde cholangiopancreatography. For obscure aetiologies, serum calcium and triglycerides should be measured. Genetic polymorphisms may play an important role in “idiopathic” acute recurrent pancreatitis.

  • ALT, alanine aminotransferase
  • APACHE-II, acute physiology and chronic health evaluation II score
  • CAPB, carboxypeptidase B
  • ERCP, endoscopic retrograde cholangiopancreatography
  • IL, interleukin
  • NPV, negative predictive value
  • SIRS, systemic inflammatory response syndrome
  • TAP, trypsinogen activated protein
  • acute pancreatitis
  • biochemical markers

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