Diagnostic accuracy of serum lipase for acute pancreatitis in adults presenting to the emergency department: a systematic review

Background: Acute pancreatitis (AP) requires rapid emergency department diagnosis, and LPS is widely used; uncertainty exist regarding optimal interpretation, especially for mild elevations. Our systematic review examined the diagnostic utility of serum lipase (LPS) for identifying AP in adults presenting with acute abdominal pain. Methods: This systematic review was conducted according to PRISMA guidelines to examine the diagnostic accuracy of LPS for AP in adults presenting to the ED with acute abdominal pain. Our data searches were performed in PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. Prospective and retrospective diagnostic accuracy and cohort studies were eligible when AP was diagnosed using the Revised Atlanta Criteria. We assessed quality using QUADAS-2 on study design, population, lipase thresholds, and diagnostic performance, and methodology. Results: Seven studies were included, and LPS showed high diagnostic accuracy, with reported sensitivity/specificity of 93.9%/99.4% in one prospective study and 96.6%/99.0% in another study. Lipase reached 100% sensitivity within the first 24 hours of symptom onset and have higher sensitivity than amylase on days 2-3 (85% vs 68%). Data favored lipase over amylase because of its longer diagnostic window. Mild elevations represented an important gray zone among patients with lipase 80-240 IU/L, only 6.36% had AP, while 64% of emergency lipase orders in another study were redundant. Conclusions: LPS is a highly accurate first-line biomarker for diagnosing AP in adults in the ED. Its value is greatest when interpreted with clinical findings and the 3× upper-limit-of-normal threshold and selective imaging when presentation is inconclusive.