Abstract
Amaç: Çalışmamızda acil servise başvuran hastalarda ne sıklıkla amilaz testi istendiğini ve bu testin etkinliğini göstermeyi amaçladık.
Gereç ve Yöntem: Amilaz tetkiki istenilen 32.922 hastadan amilaz yüksekliği (>100 IU/L) saptanan 4318’nin dosya bilgileri incelendi. Geriye kalan 1543 hasta çalışmaya dahil edildi. Hastaların demografik verileri ile laboratuvar değerleri, hastaların nihai tanıları ve ilaç bilgileri değerlendirildi.
Bulgular: Acil servise başvuran hastaların %15,1’inden amilaz tetkiki istenilmiş olup, %1,98’inde amilaz yüksekliği saptandı. Acil servisteki tanı alan akut pankreatit insidansı 100.000’de 60 olarak saptandı. Serum amilaz kestirim değeri normalin üst limitinin 3 kat ve üzeri esas alındığında amilazın akut pankreatit tanısı koymadaki sensitivitesi ve spesifitesi amilaz düzeyini yükselttiği bilinen hastalıklarla ayırımda %85,4 ve %98,0 idi. Amilazın akut pankreatit tanısı koymadaki sensitivitesi ve spesifitesi amilazı yükselttiği bilinen bir hastalık veya ilaç kullanımı olmayan hastalarla ayırımında %85,4 ve %95,3 olarak saptandı.
Sonuç: Amilaz yüksekliği akut pankreatit ile beraber diğer gastrointestinal, jinekolojik, kardiyovasküler, nörolojik hastalıklar ve renal fonksiyon bozukluklarında da görülmektedir. Acil servislerde hastalardan kliniğine göre amilaz tetkiki istenilmesi gereksiz tetkik istenilmesini önleyecektir.
Keywords
References
- [1] Slack S, Abbey I, Smith D. Reminder of important clinical lesson: Abdominal pain and hyperamylasaemia-not always pancreatitis. BMJ Case Reports. 2010.[2] Muniraj T, Dang S, Pitchumoni CS. Pancreatitis or not? Elevated lipase and amylase in ICU patients. J Crit Care. 2015; 30:1370-5.[3] Burden S, Poon ASK, Masood K. Hyperamylasaemia: pathognomonic to pancreatitis? BMJ Case Rep. 2013. [4] Souza GD, Souza LRQ, Cuenca RM, et al. Understanding the international consensus for acute pancreatitis: Classification of Atlanta 2012. Arq Bras Cir Dig. 2016; 29(3):206-10.[5] Sinha S, Khan H, Timms PM, et al. Pancreatic type hyperamylasaemia and hyperlipasemia secondary to ruptured ovarian cyst: A case report and review of the literature. J Emerg Med. 2010; 38(4):463-6.[6] Lee CC, Chung WY, Shih YH. Elevated amylase and lipase levels in the neurosurgery intensive care unit. J Chin Med Assoc. 2010; 73(1):8-14.[7] Al-Abed YA, Ghani KR, Carr TW, et al. Hyperamylasaemia in ureteric colic. Postgrad Med J. 2009; 85:108-9.[8] Cote GA, Gottstein JH, Daud A, et al. The role of etiology in the hyperamylasemia of acute liver failure. Am J Gastroenterol. 2009; 104(3):592-7.[9] Liu Z, Wang J, Quian J, et al. Hyperamylasemia, reactive plasmacytosis and immune abnormalities in a patient with celiac disease. Dig Dis Sci. 2007; 52:1444-7.[10] Liverani E, Leonardi F, Castellani L, et al. Asymptomatic and persistent elevation of pancreatic enzymes in an ulcerative colitis patient. Case Rep Gastrointest Med. 2013. [11] Bokemeyer B. Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn's disease and ulcerative colitis. Z Gastroenterol. 2002; 40(1):5-10.[12] Pezzilli R, Fabbri D, Imbrogno A, et al. Tyrosine kinase inhibitors, pancreatic hyperenzymemia and acute pancreatitis: a review. Recent Pat Inflamm Allergy Drug Discov. 2011; 5(2):165-8.[13] Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013; 108:1400-15.[14] Keller J, Andresen V, Rosien U, et al. The patient with slightly elevated pancreatic enzymes and abdominal complaints. Best Pract Res Clin Gastroenterol. 2007; 21(3):519-33.[15] Lang E, Afilalo M, Dankoff J, et al. The prognostic significance of moderate hyperamylasemia in the evaluation of the emergency department patient. J Emerg Med. 1995; 13:107-12.[16] Kiriyama S, Gabata T, Takada T, et al. New diagnostic criteria of acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010; 17(1):34-6.[17] Sutton PA, Humes DJ, Purcell G, et al. The role of routine assays of serum amylase and lipase for the diagnosis of acute abdominal pain. Ann R Coll Surg Engl. 2009; 91:381-4.[18] Shen YS, Chan CM, Chen WL, et al. Diagnostic performance of initial salivary alpha-amylase activity for acute myocardial infarction in patients with acute chest pain. J Emerg Med. 2012; 43:553-60.[19] Parissis JT, Adamopoulos SN, Venetsanou KF, et al. Elevated plasma amylase levels in advanced chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy: correlation with circulating interleukin-6 activity. J Interferon Cytokine Res. 2003; 23:329-33.[20] Jiang CF, Ng KW, Tan SW. Serum level of amylase and lipase in various stages of chronic renal insufficiency. Zhonghua Yi Xue Za Zhi (Taipei). 2002; 65:49-54.[21] Van Stegeren A, Rohleder N, Everardo W, et al. Salivary alpha amylase as marker for adrenergic activity during stress: effect of betablockade. Psychoneuroendocrinology. 2006; 31:137-41.[22] Gomez D, Addison A, De Rosa A, et al. Retrospective study of patients with acute pancreatitis: is serum amylase still required? BMJ open. 2012; 2(5):e001471.[23] Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 2016; 375(20):1972-81.
Abstract
Purpose: The aim of this study was to establish how frequent the amylase test was ordered and to determine its effectiveness in patients that apply to the emergency department.
Materials and Methods: Among the 32,922 patients who had amylase tests ordered, the data from the files of 4,318 patients with high amylase levels (>100 IU/L) were evaluated. The remaining 1,543 patients were included in the study. The demographic data, laboratory results, definitive diagnoses and medication data of the patients were evaluated.
Results: Amylase tests were ordered in 15.1% of the patients that applied to the emergency department, and high amylase levels were detected in 1.98%. The incidence of acute pancreatitis diagnosed in the emergency department was identified as 60 in 100.000. When the serum amylase cut-off value was taken as three times greater than the normal upper limit, it was identified that the sensitivity and specificity of amylase in diagnosing acute pancreatitis was 85.4% and 98.0% when distinguishing patients with diseases known to increase amylase. Sensitivity and specificity of amylase in diagnosing acute pancreatitis was 85.4% and 95.3% when distinguishing patients with no diseases known to increase amylase or no medication use.
Conclusion: Besides acute pancreatitis, increased amylase levels are also observed in other gastrointestinal, gynecological, cardiovascular, neurological diseases and renal dysfunction. Ordering amylase tests based on the patients' clinic will reduce ordering unnecessary tests in emergency departments.
Keywords
References
- [1] Slack S, Abbey I, Smith D. Reminder of important clinical lesson: Abdominal pain and hyperamylasaemia-not always pancreatitis. BMJ Case Reports. 2010.[2] Muniraj T, Dang S, Pitchumoni CS. Pancreatitis or not? Elevated lipase and amylase in ICU patients. J Crit Care. 2015; 30:1370-5.[3] Burden S, Poon ASK, Masood K. Hyperamylasaemia: pathognomonic to pancreatitis? BMJ Case Rep. 2013. [4] Souza GD, Souza LRQ, Cuenca RM, et al. Understanding the international consensus for acute pancreatitis: Classification of Atlanta 2012. Arq Bras Cir Dig. 2016; 29(3):206-10.[5] Sinha S, Khan H, Timms PM, et al. Pancreatic type hyperamylasaemia and hyperlipasemia secondary to ruptured ovarian cyst: A case report and review of the literature. J Emerg Med. 2010; 38(4):463-6.[6] Lee CC, Chung WY, Shih YH. Elevated amylase and lipase levels in the neurosurgery intensive care unit. J Chin Med Assoc. 2010; 73(1):8-14.[7] Al-Abed YA, Ghani KR, Carr TW, et al. Hyperamylasaemia in ureteric colic. Postgrad Med J. 2009; 85:108-9.[8] Cote GA, Gottstein JH, Daud A, et al. The role of etiology in the hyperamylasemia of acute liver failure. Am J Gastroenterol. 2009; 104(3):592-7.[9] Liu Z, Wang J, Quian J, et al. Hyperamylasemia, reactive plasmacytosis and immune abnormalities in a patient with celiac disease. Dig Dis Sci. 2007; 52:1444-7.[10] Liverani E, Leonardi F, Castellani L, et al. Asymptomatic and persistent elevation of pancreatic enzymes in an ulcerative colitis patient. Case Rep Gastrointest Med. 2013. [11] Bokemeyer B. Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn's disease and ulcerative colitis. Z Gastroenterol. 2002; 40(1):5-10.[12] Pezzilli R, Fabbri D, Imbrogno A, et al. Tyrosine kinase inhibitors, pancreatic hyperenzymemia and acute pancreatitis: a review. Recent Pat Inflamm Allergy Drug Discov. 2011; 5(2):165-8.[13] Tenner S, Baillie J, DeWitt J, et al. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013; 108:1400-15.[14] Keller J, Andresen V, Rosien U, et al. The patient with slightly elevated pancreatic enzymes and abdominal complaints. Best Pract Res Clin Gastroenterol. 2007; 21(3):519-33.[15] Lang E, Afilalo M, Dankoff J, et al. The prognostic significance of moderate hyperamylasemia in the evaluation of the emergency department patient. J Emerg Med. 1995; 13:107-12.[16] Kiriyama S, Gabata T, Takada T, et al. New diagnostic criteria of acute pancreatitis. J Hepatobiliary Pancreat Sci. 2010; 17(1):34-6.[17] Sutton PA, Humes DJ, Purcell G, et al. The role of routine assays of serum amylase and lipase for the diagnosis of acute abdominal pain. Ann R Coll Surg Engl. 2009; 91:381-4.[18] Shen YS, Chan CM, Chen WL, et al. Diagnostic performance of initial salivary alpha-amylase activity for acute myocardial infarction in patients with acute chest pain. J Emerg Med. 2012; 43:553-60.[19] Parissis JT, Adamopoulos SN, Venetsanou KF, et al. Elevated plasma amylase levels in advanced chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy: correlation with circulating interleukin-6 activity. J Interferon Cytokine Res. 2003; 23:329-33.[20] Jiang CF, Ng KW, Tan SW. Serum level of amylase and lipase in various stages of chronic renal insufficiency. Zhonghua Yi Xue Za Zhi (Taipei). 2002; 65:49-54.[21] Van Stegeren A, Rohleder N, Everardo W, et al. Salivary alpha amylase as marker for adrenergic activity during stress: effect of betablockade. Psychoneuroendocrinology. 2006; 31:137-41.[22] Gomez D, Addison A, De Rosa A, et al. Retrospective study of patients with acute pancreatitis: is serum amylase still required? BMJ open. 2012; 2(5):e001471.[23] Forsmark CE, Vege SS, Wilcox CM. Acute Pancreatitis. N Engl J Med. 2016; 375(20):1972-81.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research |
| Authors | |
| Publication Date | June 30, 2019 |
| Acceptance Date | November 21, 2018 |
| Published in Issue | Year 2019 Volume: 44 Issue: 2 |
