Diagnostic accuracy of serial serum lipase measurements in blunt pancreatic trauma: a prospective evaluation integrated with early computed tomography
Turkish Journal of Biochemistry, 2026 (SCI-Expanded, Scopus, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Basım Tarihi: 2026
- Doi Numarası: 10.1515/tjb-2025-0538
- Dergi Adı: Turkish Journal of Biochemistry
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Applied Science & Technology Source, EMBASE, Food Science & Technology Abstracts, Directory of Open Access Journals, TR DİZİN (ULAKBİM)
- Anahtar Kelimeler: lipase, amylase, emergency medicine, trauma, pancreatic injury
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Objectives: Pancreatic trauma presents significant diagnostic challenges due to its subtle clinical presentation and potential for severe complications. This study assesses the diagnostic performance of both enzymes and investigates whether a protocol combining scheduled 6-h lipase measurements with an early computed tomography (CT)-based algorithm enhances overall accuracy. Methods: We performed a prospective diagnostic accuracy study at a Level III trauma center, enrolling 300 patients with abdominal trauma. Serum amylase and lipase were measured at admission (T0) and 6 h post-admission (T6) if initial levels were normal. Contrast-enhanced CT served as the reference standard, with injuries graded using the American Association for the Surgery of Trauma (AAST) injury score. Subgroup analyses included pediatric patients and trauma mechanisms. Results: Pancreatic injury was confirmed in 9.3 % of cases (n=28), predominantly moderate-to-high grade (61 %). Lipase demonstrated superior diagnostic accuracy to amylase (area under the curve 0.89 vs. 0.74, p<0.001), with an optimal cutoff ≥3 × the upper limit of normal (sensitivity 86.4 %, specificity 88.9 %, negative predictive value 98.6 %). Lipase testing at 6 h identified an additional 11.5 % of injuries, improving sensitivity to 92.3 %. The sensitivity in children was much lower than in adults (62.5 % vs. 90.9 %, p=0.03). Lipase levels correlated with injury severity (ρ=0.35, p=0.02). Grade III-V injuries show higher values than grade I-II injuries (6.2 × vs. 2.8 × upper limit of normal, p=0.004). Conclusions: Integrating 6-h serum lipase measurements may enhance the detection of pancreatic trauma-raising sensitivity from 86.4 % to 92.3 %. This dynamic, time-based approach offers a cost-effective adjunct to imaging, with a high negative predictive value, and it has the potential to reduce unnecessary repeat CT scans.