The effect of serum lipase levels on clinical severity scores and mortality in acute pancreatitis: a retrospective cohort study

AIMS: This study aimed to investigate the relationship between admission serum lipase levels, prognostic clinical scoring systems, and in-hospital mortality in patients presenting to the emergency department with acute pancreatitis. METHODS: This retrospective cohort study included 389 patients hospitalized with acute pancreatitis at a tertiary care center between 2021 and 2023. Demographic characteristics, clinical findings, laboratory parameters obtained at admission and at 48 h, and imaging findings were collected. Prognostic assessment was performed using the Ranson, APACHE II, BISAP, Glasgow-Imrie, HAPS, and CTSI scoring systems. Patients were categorized according to a predefined serum lipase cutoff of 600 U/L. The associations between serum lipase levels, prognostic score categories, and in-hospital mortality were analyzed, and the diagnostic performance of the lipase cutoff was evaluated. RESULTS: The overall in-hospital mortality rate was 3.9% (n = 15). Admission serum lipase levels were significantly associated with the Ranson score (p < 0.05) and several laboratory parameters. A serum lipase cutoff of 600 U/L identified patients with a Ranson score ≥ 3 with a sensitivity of 70.2% (95% CI: 60.4-78.8) and a specificity of 57.3% (95% CI: 51.2-63.2). Higher prognostic scores, including Ranson, BISAP, and APACHE II, were significantly associated with in-hospital mortality (p < 0.01). However, admission serum lipase levels were not significantly associated with in-hospital mortality. CONCLUSION: Admission serum lipase showed a limited association with selected prognostic indicators in acute pancreatitis but was not associated with in-hospital mortality. These findings suggest that serum lipase has limited value as a standalone prognostic marker and should be interpreted in conjunction with established clinical scoring systems. Further prospective studies are needed to better clarify its role in risk assessment.