Amylase, Plasma (LAB48) and Lipase, Plasma (LAB99)

Plasma lipase is the preferred biomarker for acute pancreatitis

Clinical Background
  • The activity of both amylase and lipase is increased in plasma shortly after the onset of acute pancreatitis. Due to differences in clearance and tissue specificity, elevated plasma lipase is a more sensitive and specific biomarker of acute pancreatitis than amylase. Although both enzymes are frequently ordered together, concurrent measurement of amylase and lipase does not improve diagnostic efficiency and may increase healthcare costs. 
Common Pitfalls
  • Plasma amylase activity returns to baseline sooner than lipase following the onset of acute pancreatitis, narrowing the diagnostic time window. 
  • Once a diagnosis is established, additional measurements of lipase or amylase have limited clinical utility.
  • Amylase may be falsely elevated in certain conditions such as macroamylasemia, decreased glomerular filtration rate, diseases of salivary glands and in extra-pancreatic abdominal disease associated with inflammation (e.g., acute appendicitis, cholecystitis, gynecological diseases).
  • Conversely, serum amylase concentrations may be normal in alcohol-induced acute pancreatitis and hyperamylasemia.
  • Severity and etiology of acute pancreatitis cannot be established by serum concentrations of amylase or lipase.
Key Takeaways
  • Plasma lipase activity >3x the upper reference limit is the most sensitive and specific biomarker of acute pancreatitis.
  • Simultaneous measurement of plasma amylase and lipase is not recommended for workup of acute pancreatitis.
References
  1. Choosing Wisely. Facts and figures. http://www.choosingwisely.org/our-mission/facts-and-figures/. Accessed May 16th, 2024
  2. Ritter JP et al. Cost of Unnecessary Amylase and Lipase Testing at Multiple Academic Health Systems. Am J Clin Pathol. 2020 Feb 8;153(3):346-352.
  3. Tenner et al. American College of Gastroenterology Guidelines: Management of Acute Pancreatitis. Am J Gastroenterology. 2024;119(3):419-437.
  4. Ismail OZ & Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis? Clin Biochem. 2017; 50(18):1275-1280.

Written By: Steven Roper, PhD

Reviewed By: Ann M. Gronowski, PhD

Last Edited: 2024-08-28

Last Reviewed: 2024-08-28