Three-hour postoperative pancreatic enzymes levels for early prediction of pancreatitis following ERCP / 中华全科医师杂志

ABSTRACT

Objective:To investigate the predictive value of 3-hour post-endoscopic retrograde cholangiopancreatography (ERCP) serum amylase and lipase levels for postoperative pancreatitis (PEP).Methods:Clinical data of patients who underwent ERCP from June 2017 to December 2018 in our hospital were retrospectively analyzed. Risk factors of PEP were examined with univariate and multivariate analysis. Receiver operator characteristic (ROC) curve for 3-h postoperative serum amylase and lipase was generated and the optimal cut-off levels for PEP prediction were calculated.Results:A total of 491 patients were enrolled in this study, and 29 patients developed PEP. Compared with the uncomplicated group, female gender [75.9% (22/29) vs. 49.1% (227/462)], pancreatogram [65.5% (19/29) vs. 32.0% (148/462)], pancreatic duct cannulation [27.6% (8/29) vs. 11.7% (54/462)] and coronary heart disease [17.2% (5/29) vs. 4.5% (21/462)] accounted for a significant higher proportion in PEP group (χ 2=7.79, 13.63, 6.25, 6.42, all P<0.05), while logistic regression analysis revealed that only pancreatic duct cannulation was an independent risk factor ( OR=3.574, 95 %CI 1.315-9.713, P<0.05). Areas under the ROC curve of serum amylase and lipase at 3 h were 0.897 (95 %CI 0.842-0.951, P<0.01) and 0.915 (95 %CI 0.881-0.948, P<0.01), respectively ( Z=0.550, P>0.05). For amylase, ideal sensitivity(93.1%) and specificity(93.3%) could be obtained as cut-off levels>1.0 and 3.0 times the upper limit reference (ULR), respectively. Correspondingly, as cut-off levels for lipase>2.5 and 6.0 times the ULR, the sensitivity was 93.1% and specificity was 91.3%, respectively. Conclusion:Three-hour postoperative serum amylase and lipase are both ideal indicators for predicting PEP with similar clinical value.