Non-pancreatic hyperlipasemia: A puzzling clinical entity

doi:10.3748/wjg.v30.i19.2538

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Gastroenterol. May 21, 2024; 30(19): 2538-2552
Published online May 21, 2024. doi: 10.3748/wjg.v30.i19.2538

Table 1 Demographic, clinical and laboratory characteristics at enrolment and outcome data of the acute pancreatitis and non-pancreatic hyperlipasemia patients, n (%)

	AP (n = 392)	NPHL (n = 401)	P value
Gender (male)	188 (48)	221 (55.1)	0.047
Age (yr)	62 (47-73)	66 (57-76)	< 0.001
Comorbidities any	310 (79)	369 (92)	< 0.001
CCI	3 (1-5)	5 (3-8)	< 0.001
Sepsis (yes)	56 (14.3)	111 (27.7)	< 0.001
Acute kidney injury (yes)	41 (10.5)	133 (33.2)	< 0.001
Sepsis and AKI (yes)	20 (5.1)	82 (20.4)	< 0.001
Lipase level (U/L)	1331 (579-2837)	278 (236-485)	< 0.001
Amylase level (U/L)	424 (172-1038)	170 (97-249)	< 0.001
Sodium (mmol/L)	139 (136-141)	139 (136-142)	0.568
Albumin (g/L)	39 (33-44)	35 (29-41)	< 0.001
BUN (mmol/L)	5.3 (3.7-7.8)	8.4 (5-20.35)	< 0.001
Creatinine (μmol/L)	73 (60-94)	92 (63-217)	< 0.001
GFR (mL/p/1.73m²)	87 (61-91)	61 (24-91)	< 0.001
WBC (G/L)	10.79 (7.81-14.45)	10.39 (7.63-14.61)	0.805
Neutrophil granulocyte (G/L)	8.46 (5.49-11.97)	7.87 (5.20-11.83)	0.584
Lymphocyte (G/L)	1.27 (0.83-1.82)	1.29 (0.82-1.89)	0.008
NLR	6.52 (3.54-12.93)	6.03 (3.21-12.40)	< 0.001
CRP (mg/L)	19.5 (5.8-95.34)	36.85 (10.88-101.93)	0.008
PCT (μg/L)	0.24 (0.09-0.69)	0.76 (0.25-3.13)	< 0.001
Total length of hospitalization (d)	7 (4-12)	8 (3-18)	0.126
ICU (yes)	174 (44.4)	182 (45.4)	0.830
ICU stay (d)	4 (2-7)	7 (3-16)	< 0.001
In-hospital mortality	20 (5.1)	90 (22.4)	< 0.001

Data are presented as median (interquartile range) if not otherwise indicated. For procalcitonin, the number of patients was 274 in non-pancreatic hyperlipasemia group and 238 in acute pancreatitis group. AP: Acute pancreatitis; NPHL: Non-pancreatic hyperlipasemia; IQR: Interquartile range; BUN: Blood urea nitrogen; GFR: Glomerular filtration rate; WBC: White blood cell; NLR: Neutrophil-to-lymphocyte ratio; CRP: C-reactive protein; PCT: Procalcitonin; ICU: Intensive care unit; CCI: Charlson Comorbidity Index; AKI: Acute kidney injury.

Table 2 Etiologic classification of hyperlipasemia without acute pancreatitis

	Patients number (n = 401)	Percentage (%)
Gastric and bowel disorders
Peptic ulcer	2	0.5
GI bleeding	4	1
Bowel necrosis/perforation	4	1
Bowel obstruction	8	2
IBD	5	1.2
Hepatobiliary disorders
Cholecystitis	8	2
Cholangitis	13	3.2
Liver disease	14	3.5
Post-ERCP lipasemia	16	4
Cancers
Pancreatic cancers	22	5.5
Non-pancreatic cancers	27	6.7
Haematological malignancies	6	1.5
Diabetes
Type 2 diabetes mellitus	19	4.7
Diabetic ketoacidosis	6	1.5
Neurosurgical pathology	16	4
Cardiovascular disease	17	4.2
Drugs side effect	17	4.2
Other	5	1.2
Infection without sepsis	30	7.5
Infection with sepsis
Sepsis without AKI	29	7.2
Sepsis with AKI	82	20.4
AKI without sepsis	51	12.7

All patients had elevated serum lipase level (> 210 U/L). GI: Gastrointestinal; IBD: Inflammatory bowel disease; ERCP: Endoscopic retrograde cholangiopancreatography; AKI: Acute kidney injury.

Table 3 Mortality as a function of different laboratory parameter in the group with non-pancreatic hyperlipasemia

	Survivors (n = 311)	Non-survivors (n = 90)	P value	AUROC	95%CI
Lipase (U/L)	278 (236-477)	288 (240-561)	0.311	0.535	0.464-0.606
Amylase (U/L)	175 (108-240)	221 (137-354)	0.001	0.618	0.543-0.693
Sodium (mmol/L)	139 (136-142)	139 (133-144)	0.78	0.510	0.430-0.589
Albumin (g/L)	36 (30-42)	29 (25-35)	< 0.001	0.725	0.665-0.784
BUN (mmol/L)	7 (4.6-15.7)	19.6 (9.2-35.4)	< 0.001	0.724	0.666-0.783
Creatinine (µmol/L)	83 (62-170)	166 (78-334)	< 0.001	0.638	0.570-0.705
GFR (mL/p/1.73 m²)	74 (32-91)	29 (13-79)	< 0.001	0.653	0.588-0.719
WBC (G/L)	9.63 (7.23-13.37)	13.19 (9.34-20.98)	< 0.001	0.679	0.615-0.743
Neutrophil granulocyte (G/L)	6.80 (4.80-10.83)	11.11 (7.89-17.76)	< 0.001	0.715	0.655-0.775
Lymphocyte (G/L)	1.39 (0.89-1.97)	0.98 (0.62-1.56)	< 0.001	0.634	0.564-0.703
NLR	5.24 (2.84-9.66)	12.64 (6.64-19.50)	< 0.001	0.747	0.691-0.803
CRP (mg/L)	27.35 (9.23-81.36)	84.74 (34.13-135.34)	< 0.001	0.696	0.637-0.756
PCT (µg/L)	0.6 (0.21-2.04)	2.16 (0.41-4.23)	0.002	0.620	0.546-0.694

For procalcitonin, the number of patients was 197 in survivor group and 77 in non- survivor group. BUN: Blood urea nitrogen; GFR: Glomerular filtration rate; WBC: White blood cell; NLR: Neutrophil-to-lymphocyte ratio; CRP: C-reactive protein; PCT: Procalcitonin. AUROC: Area under the receiver operating characteristic; CI: Confidence interval.

Table 4 Multivariable logistic regression of in-hospital mortality in patients with non-pancreatic hyperlipasemia

	OR	95%CI	P value
Age	1.024	1.004-1.044	0.019
Sepsis	2.087	1.115-3.906	0.021
NLR (> 10.37)	3.71	2.006-6.863	< 0.001
Amylase (> 244 U/L)	2.593	1.393-4.829	0.003
Albumin (≤ 34 g/L)	3.466	1.826-6.577	< 0.001
Constant	0.009		< 0.001

NLR: Neutrophil-to-lymphocyte ratio; OR: Odds ratio; CI: Confidence interval.

Table 5 Serum lipase and amylase levels according to the presence of complications in patients with non-pancreatic hyperlipasemia (n = 401)

	No. of patients	Lipase (U/L)		Amylase (U/L)
	No. of patients	Median	IQR	Median	IQR
No complications	239	264	229-428	159	106-226
Sepsis at all	111	425	263-651	216	112-343
AKI at all	133	398	259-625	190	99-335
AKI or sepsis	80	282	242-527	209	125-353
Sepsis and AKI	82	447	275-667	220	128-344
		P value		P value
None/sepsis at all		< 0.001		< 0.001
None/AKI at all		< 0.001		0.003
None/one (AKI or sepsis)		0.042		0.009
None/both (sepsis and AKI)		< 0.001		0.001

AKI: Acute kidney injury; AP: Acute pancreatitis; NPHL: Non-pancreatic hyperlipasemia; IQR: Interquartile range.

Table 6 Serum lipase and amylase levels according to the presence of complications in patients with acute pancreatitis (n = 392)

	No. of patients	Lipase (U/L)		Amylase (U/L)
	No. of patients	Median	IQR	Median	IQR
No complications	315	1287	577-2781	460	184-1064
Sepsis at all	56	1572	613-4588	485	199-1019
AKI at all	41	1370	511-4393	406	178-1381
AKI or sepsis	57	1529	611-4430	512	198-1123
Sepsis and AKI	20	1293	566-5175	447	188-1706
		P value		P value
None/sepsis at all		0.386		0.696
None/AKI at all		0.862		0.698
None/one (AKI or sepsis)		1.000		1.000
None/both (sepsis and AKI)		1.000		1.000

AKI: Acute kidney injury; AP: Acute pancreatitis; NPHL: Non-pancreatic hyperlipasemia; IQR: Interquartile range.

Table 7 Performance characteristics of lipase in identifying acute pancreatitis in various clinical settings

	Cut-off values (U/L)	Sensitivity (%)	Specificity (%)	LR+	LR-	PPV (%)	NPV (%)
AP overall	> 666	71.4	88.8	6.37	0.32	86.2	76.1
AP without complications	> 666	71.1	95.0	14.16	0.30	94.9	71.4
AP with sepsis	> 861	64.3	88.3	5.49	0.40	73.5	83.1
AP with AKI	> 951	58.5	92.5	7.79	0.45	70.6	87.9
AP with AKI or sepsis	> 722	71.9	90.0	7.19	0.31	83.7	81.8
AP with both complications	> 1587	50.0	97.6	20.5	0.51	83.3	88.9

AP: Acute pancreatitis; NPHL: Non-pancreatic hyperlipasemia; LR+: Positive likelihood ratio; LR-: Negative likelihood ratio; PPV: Positive predictive value; NPV: Negative predictive value; AKI: Acute kidney injury.

Table 8 Performance characteristics of amylase in identifying acute pancreatitis in various clinical settings

	Cut-off values (U/L)	Sensitivity (%)	Specificity (%)	LR+	LR-	PPV (%)	NPV (%)
AP overall	> 365	54.6	88.0	4.54	0.52	82.6	64.9
AP without complications	> 354	55.6	93.8	8.93	0.47	92.6	60.1
AP with sepsis	> 560	46.4	92.3	6.04	0.58	76.5	76.2
AP with AKI	> 502	46.3	91.8	5.65	0.58	65.5	83.6
AP with AKI or sepsis	> 271	68.5	70.8	2.35	0.45	65.0	73.9
AP with both complications	> 542	45.0	93.5	6.93	0.59	64.3	86.7

Citation: Feher KE, Tornai D, Vitalis Z, Davida L, Sipeki N, Papp M. Non-pancreatic hyperlipasemia: A puzzling clinical entity. World J Gastroenterol 2024; 30(19): 2538-2552
URL: https://www.wjgnet.com/1007-9327/full/v30/i19/2538.htm
DOI: https://dx.doi.org/10.3748/wjg.v30.i19.2538