Journal of Pediatric Gastroenterology & Nutrition:
Letters to the Editor
*School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney
†Department of Gastroenterology, John Hunter Children's Hospital and Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Newcastle Australia
To the Editor: We thank Dr Fabre and colleagues for their interest in our study regarding the use of serum lipase concentrations as an early predictor of severity in pediatric acute pancreatitis (AP) (1), and for sharing the results of their analysis in their own patient population. We assume that all levels were performed within 24 hours of presentation. In particular, their finding of serum lipase ≥7 × upper limit of normal (ULN) predicting severe AP in children is strikingly similar to our own results in a separate patient population, further validating this finding. As indicated, when compared with previously validated severity scores in AP, the sensitivity of serum lipase ≥7 × ULN within 24 hours of presentation (85% in Coffey et al (1) and 80% in Fabre et al) was superior to the Ranson, Glasgow, and DeBanto Scale scores (with sensitivities of 62%, 54%, and 54%, respectively) but with poorer specificity (2).
We agree that to date, an early predictor of severe AP in children with both high sensitivity and specificity has not yet been identified. For now, we propose that serum lipase may be used for risk stratification (to rule out most cases of severe AP) within 24 hours of presentation, whereas scoring systems such as the DeBanto (3), Ranson (4), and Glasgow (5) could be applied after 48 hours to provide adjunctive prognostic information.
1. Coffey MJ, Nightingale S, Ooi CY. Serum lipase as an early predictor of severity in pediatric acute pancreatitis. J Pediatr Gastroenterol Nutr
2. Fabre A, Petit P, Gaudart J, et al. Severity scores in children with acute pancreatitis. J Pediatr Gastroenterol Nutr
3. DeBanto JR, Goday PS, Pedroso MR, et al. Acute pancreatitis in children. Am J Gastroenterol
4. Ranson JHC, Rifkind KM, Roses DF, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet
5. Blamey SL, Imrie CW, O’Neill J, et al. Prognostic factors in acute pancreatitis. Gut