Evaluating the Role of Urinary Amylase in Diagnosing Acute Pancreatitis: A Systematic Review and Meta-Analysis

Acute pancreatitis is a life-threatening and increasingly common condition. Although serum amylase and lipase are established diagnostic markers, the clinical relevance of urinary amylase is still uncertain. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of urinary amylase in adults with suspected acute pancreatitis. We registered our review with PROSPERO (CRD42024528325) and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. We systematically searched PubMed, EMBASE, Ovid Medline, Scopus, the Cochrane Library, and Web of Science for studies of adult patients with acute abdominal pain who had quantitative urinary amylase measurements performed. Two reviewers independently screened articles for inclusion and extracted data from eligible studies. The risk of bias and applicability of the included studies were assessed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Our search identified 178 studies, of which eight met the inclusion criteria; three cross-sectional studies and two case-control studies were included in the meta-analysis. Urinary amylase had a sensitivity of 0.80 (95% confidence interval (CI): 0.65-0.89) and specificity of 0.86 (95% CI: 0.76-0.93) at a model-derived optimal threshold of 1,373 IU/L. Our results indicate that urinary amylase does not appear to outperform serum amylase, and its suggested utility in delayed or atypical presentations of acute pancreatitis remains unsubstantiated.