The Role of Etiology in the Hyperamylasemia of Acute Liver Failure

Overview

Journal Am J Gastroenterol

Specialty Gastroenterology

Date 2009 Feb 19

PMID 19223884

Citations 8

Authors

Gregory A Cote

Jeanne H Gottstein

Amna Daud

Andres T Blei

Affiliations

Soon will be listed here.

Abstract

Objectives: Hyperamylasemia (HA) is often reported in patients with acute liver failure (ALF). Direct toxic effects of acetaminophen on the pancreas have been postulated, but the occurrence of HA in other etiologies raises the question of whether multiorgan failure is part of the pathogenesis of HA in this setting. Our main aim was to describe and analyze the incidence, clinical characteristics, and outcomes of HA in ALF of different etiologies.

Methods: Patients enrolled in the Acute Liver Failure Study Group registry with an admission amylase value available were included. For the purpose of this analysis, HA was defined as > or =3x upper limits of normal. Patients were classified as having acetaminophen (APAP)- or non-APAP-induced ALF, and by amylase group: normal (<115), mildly elevated (115-345), or HA (>345). Significant variables identified by univariate analysis were added to a multiple linear regression model. The primary outcome was overall survival.

Results: In total, 622 eligible patients were identified in the database, including 287 (46%) with APAP-induced ALF; 76 (12%) patients met the criteria for HA. Among patients with HA, 7 (9%) had documented clinical pancreatitis. The incidence of HA was similar among APAP (13%) and non-APAP (12%) patients. Although HA was associated with renal failure and greater Model for End-stage Liver Disease scores for both groups, HA was not an independent predictor of mortality in multivariate analysis.

Conclusions: Although not an independent predictor of mortality, HA in ALF was present in all etiologies and was associated with diminished overall survival. HA appeared to be related to renal dysfunction in both groups and multiorgan failure in non-APAP ALF.

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References

Polderman K . Application of therapeutic hypothermia in the intensive care unit. Opportunities and pitfalls of a promising treatment modality--Part 2: Practical aspects and side effects. Intensive Care Med. 2004; 30(5):757-69. DOI: 10.1007/s00134-003-2151-y. View

Kamath P, Wiesner R, Malinchoc M, Kremers W, Therneau T, Kosberg C . A model to predict survival in patients with end-stage liver disease. Hepatology. 2001; 33(2):464-70. DOI: 10.1053/jhep.2001.22172. View

Levitt M, Rapoport M, COOPERBAND S . The renal clearance of amylase in renal insufficiency, acute pancreatitis, and macroamylasemia. Ann Intern Med. 1969; 71(5):919-25. DOI: 10.7326/0003-4819-71-5-919. View

Collen M, Ansher A, Chapman A, Mackow R, Lewis J . Serum amylase in patients with renal insufficiency and renal failure. Am J Gastroenterol. 1990; 85(10):1377-80. View

Larson A, Polson J, Fontana R, Davern T, Lalani E, Hynan L . Acetaminophen-induced acute liver failure: results of a United States multicenter, prospective study. Hepatology. 2005; 42(6):1364-72. DOI: 10.1002/hep.20948. View

Yadav D, Agarwal N, Pitchumoni C . A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol. 2002; 97(6):1309-18. DOI: 10.1111/j.1572-0241.2002.05766.x. View

Schmidt L, Dalhoff K . Hyperamylasaemia and acute pancreatitis in paracetamol poisoning. Aliment Pharmacol Ther. 2004; 20(2):173-9. DOI: 10.1111/j.1365-2036.2004.02070.x. View

Preuss J, Lignitz E, Dettmeyer R, Madea B . Pancreatic changes in cases of death due to hypothermia. Forensic Sci Int. 2006; 166(2-3):194-8. DOI: 10.1016/j.forsciint.2006.05.034. View

Ostapowicz G, Fontana R, Schiodt F, Larson A, Davern T, Han S . Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med. 2002; 137(12):947-54. DOI: 10.7326/0003-4819-137-12-200212170-00007. View

10.

Foulis A . Morphological study of the relation between accidental hypothermia and acute pancreatitis. J Clin Pathol. 1982; 35(11):1244-8. PMC: 497936. DOI: 10.1136/jcp.35.11.1244. View

11.

OGrady J, Schalm S, Williams R . Acute liver failure: redefining the syndromes. Lancet. 1993; 342(8866):273-5. DOI: 10.1016/0140-6736(93)91818-7. View

12.

Hirano T, Manabe T, Calne R, Printz H . Effect of hypothermia on pancreatic acinar cells in rats. Nihon Geka Hokan. 1992; 61(4):320-33. View

13.

Savides E, Hoffbrand B . Hypothermia, thrombosis, and acute pancreatitis. Br Med J. 1974; 1(5908):614. PMC: 1633444. DOI: 10.1136/bmj.1.5908.614. View

14.

Cholongitas E, Senzolo M, Patch D, Kwong K, Nikolopoulou V, Leandro G . Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit. Aliment Pharmacol Ther. 2006; 23(7):883-93. DOI: 10.1111/j.1365-2036.2006.02842.x. View

15.

OGrady J, Alexander G, Hayllar K, Williams R . Early indicators of prognosis in fulminant hepatic failure. Gastroenterology. 1989; 97(2):439-45. DOI: 10.1016/0016-5085(89)90081-4. View

16.

Stravitz R, Lee W, Kramer A, Kramer D, Hynan L, Blei A . Therapeutic hypothermia for acute liver failure: toward a randomized, controlled trial in patients with advanced hepatic encephalopathy. Neurocrit Care. 2008; 9(1):90-6. DOI: 10.1007/s12028-008-9090-y. View

17.

Ede R, Moore K, Marshall W, Williams R . Frequency of pancreatitis in fulminant hepatic failure using isoenzyme markers. Gut. 1988; 29(6):778-81. PMC: 1433740. DOI: 10.1136/gut.29.6.778. View

18.

Weaver D, Busuito M, Bouwman D, Wilson R . Interpretation of serum amylase levels in the critically ill patient. Crit Care Med. 1985; 13(7):532-3. DOI: 10.1097/00003246-198507000-00003. View

19.

Vaquero J, Blei A . Mild hypothermia for acute liver failure: a review of mechanisms of action. J Clin Gastroenterol. 2005; 39(4 Suppl 2):S147-57. DOI: 10.1097/01.mcg.0000155515.94843.55. View

20.

Maclean D, Murison J, Griffiths P . Acute pancreatitis and diabetic ketoacidosis in accidental hypothermia and hypothermic myxoedema. Br Med J. 1973; 4(5895):757-61. PMC: 1587988. DOI: 10.1136/bmj.4.5895.757. View