Amylase was one of the earliest tests used for identifying acute pancreatitis among those presenting with abdominal pain Since then lipase has been introduced and offers superior sensitivity and ID: 908715
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Amylase was one of the earliest tests used for identifying acute pancreatitis
among those presenting with abdominal pain.
Since then, lipase has been introduced and offers superior sensitivity and
specificity compared to amylase for diagnosing acute pancreatitis.
The amylase is routinely ordered with co-ordering of amylase and lipase seen in 90% of the cases secondary to the belief that co-ordering these provides greater accuracy than either test alone. At a diagnostic threshold of 208 U/L for lipase and 114 U/L for amylase, lipase compared to amylase had a superior sensitivity (90.3% vs 78.7%), specificity (93.0% vs 92.6%), positive likelihood ratio (14.1 vs 10.6), and a similar negative likelihood ratio (0.1 vs 0.1). The lipase also remains elevated longer than amylase and is useful in delayed presentations of acute pancreatitis. Neither of these tests correlates with severity or clinical resolution of pancreatitis and are not included in any of the severity tools, like Ranson's criteria, APACHE II or CT severity index. The 2013 ACG guidelines recommend ordering lipase alone, stating serum amylase alone cannot be used reliably and that serum lipase is preferred. The lipase is alone sufficient for the diagnosis rather than ordering both the amylase and lipase.
CONCLUSION
RESULTS
INTRODUCTION
METHODS
In the evaluation of acute pancreatitis, amylase, when compared to lipase, has inferior sensitivity and specificity, adds no additional diagnostic information when co-ordered, and does not provide additional prognostic information. The guidelines recommend ordering lipase alone rather than either amylase alone or co-ordering amylase and lipase, and also against the daily monitoring of pancreatic enzymes as it do not help assess clinical progress or severity of illness.
We performed a retrospective observational study of all patients who received the amylase test at UMMC from January 3, 2013 to December 31, 2019. The de-identified patient data was obtained from the EPIC charts. We obtained the number of encounters and patients on whom the amylase test was performed. Coding and billing offices provided the cost per test (CPT code 82150) at $ 63 per test for the year 2020.
IMAGES:Graphs depicting the Amylase testing data and trends.
UTILIZATION AND THE COST BURDEN ANALYSIS OF AMYLASE TESTING IN ACUTE PANCREATITIS
Himmat S. Brar
1
, Jannat Kang
2 and Pradeep Bathina3Department of Internal Medicine, University of Mississippi Medical Center
Amylase test was ordered 26,448 times on 15,864 patients between 2013 and 2019. 4167, 4127, 4175, 3946, 3533, 3081, 2952 tests were done respectively from 2013 to 2019 with a declining trend since 2015. Majority (22,287) tests were ordered only once per encounter and 4,161 tests were done as repeat tests during the same encounter. The test was ordered twice in 1882 encounters, thrice in 711, 4 times in 360, 5 times in 228, 6 times in 99 with a maximum of 19 times in 1 encounter. The median age of the patient was 43. More tests were done in females (58%) than males (42%). The majority tests were in African Americans (56.6%) followed by Caucasians (41.1%) and 2.3% in others/unknown. Of the 26,448 tests, 6,128 (23%) were >100 U/L, that is the upper limit of normal and 1,018 (3.8%) were >300 U/L, that is three times the upper limit of normal. With $63 per test a total of $1,666,224 was spent on amylase testing between years 2013 to 2019, with an average expenditure of 238,032 each year. The total cost of repeat tests during the same encounter was $262,143.
Graph depicting the trends of Amylase testing over the years.
Pie chart depicting
the percentage of tests.
Number
of times the test done
Number of people
2 1882 3 711 4 360 5 228 6 99 7 73 >8 202
Graph and Pie Chart depicting the levels of the Amylase testing
REFERENCES
American College of Gastroenterology (ACG)
PubMed American Association for the Study of Liver Diseases (AASLD)