Inflammation of the Pancreas: Test and Diagnosis

1st-order laboratory parameters – obligatory laboratory tests in acute pancreatitis.

  • CRP (C-reactive protein) [differentiate mild vs severe course: > 150 mg/dl 48 h] or PCT (procalcitonin) [indicator of severity].
  • Serum amylase
  • Lipase [acute pancreatitis: ≥ 3-fold of upper normal]
  • Trypsin
  • Elastase in serum
  • Small blood count [hematocrit: high negative predictive value (NPW) for a hematocrit > 44%; good marker to exclude a severe course].
  • Calcium (calcium level < 2 mmol/l: severe course), potassium, magnesium, sodium.
  • Lipids, especially triglycerides
  • Fasting glucose [serum glucose concentration < 6.9 mmol/l (
  • PTT, Quick
  • Albumin, bilirubin, transaminases (GOP, GPT), AP, LDH [GPT: triple elevated GPT in gallstone-induced pancreatitis; best marker: 90% predictive value. 50% sensitivity]
  • Urea, creatinine, cystatin C or creatinine clearance as appropriate [serum creatinine: predictor of pancreatic necrosis identified][serum urea nitrogen: high predictive value for severe course].
  • High-sensitivity cardiac troponin T (hs-cTnT) or troponin I (hs-cTnI).
  • Blood gas analysis (ABG); determination of:

The diagnosis of acute pancreatitis is usually based on an elevated serum amylase. After 48 to 72 hours, this value returns to normal, although pancreatitis may persist. On the other hand, elevated amylase and lipase levels may also persist for 7 to 14 days. The determination of amylase and lipase at the same time increases diagnostic certainty.CRP and elastase are particularly suitable for assessing the severity of the disease, while amylase and lipase are unsuitable for this purpose. Furthermore, elevated urea values indicate an unfavorable course. Laboratory parameters of the 2nd order – for monitoring the course or detecting complications.

  • Inflammatory parameter CRP (C-reactive protein) [>15 mg/dl within the first 72 h → indication of a severe course].
  • Hb, Hk [normal hematocrit on admission and after 48 h → low risk of complications]
  • Calcium [normal values → low risk of complications]
  • Glucose [severe course: > 10 mmol/L]
  • Albumin [severe course: < 32 g/L]
  • LDH [severe course:> 600 IU/L]
  • GOT [severe course:> 200 IU/L]
  • Creatinine
  • Urea [increase within first 24 h → associated with increased lethality; severe course: > 16 mmol/L]

Prognostic parameters.

Signs of unfavorable parameters (see also under sequelae/prognostic factors: modified Glasgow criteria).

Initial In the course
Age > 55 yrs. CRP > 150 mg/dl
BMI > 30 kg/m2 Hk drop > 10
Leukos > 16,000/μl Calcium < 2.0 mmol/l
Glucose > 200 mg/dl(= 11.1 mmol/l) pO2 < 60 mmHg
LDH > 350 U/l Fluid deficit > 6 l
GPT > 120 U/l Urine < 50 ml/h
Fever (rect.) > 38.5 °C Shock, tachycardia

Bedside-index-of-severity-in-acute-pancreatitis (BISAP) scores – see below for classificationLaboratory parameters 1st order – mandatory laboratory tests in chronic pancreatitis.

  • Fecal elastase (3 samples on 3 days) – for diagnosis of exocrine pancreatic insufficiency (EPI; disease of the pancreas associated with insufficient production of digestive enzymes).
  • Pancreolauryl test
  • Elastase in serum

In the acute episode of chronic pancreatitis, the same laboratory diagnostics are performed as in acute pancreatitis. It should be noted that the amylase and lipase are often in the normal range, because due to the chronic course of functional pancreatic tissue has been destroyed.Elevated glucose (blood glucose) may indicate a rare painless pancreatitis. In the case of exocrine pancreatic insufficiency (EPI; disease of the pancreas associated with insufficient production of digestive enzymes), stool tests are required (see Pancreatic insufficiency/Laboratory diagnostics).Furthermore, in chronic pancreatitis, pancreatic function tests such as the secretin-pancreocymin or fluorescein dilaurate test (pancreoauryl test) are performed to assess exocrine pancreatic function. However, they are rarely used due to very laborious performance. Fasting glucose (fasting blood sugar) (pathological: > 126 mg/dl; >7 mmol/l) and HbA1c determination (pathological: ≥ 6.5%) should be used to diagnose endocrine pancreatic insufficiency (pancreas produces less or no insulin). In case of doubt, the performance of an oral glucose tolerance test with 75 g glucose is recommended. According to the current guideline, diagnostics should be performed annually.2nd-order laboratory parameters – depending on the results of the medical history, physical examination, etc. – for differential diagnostic clarification

  • If autoimmune pancreatitis is suspected – immunoglobulins Ig G4.
  • Gamma-GT and CDT (Carbohydrate Deficient Transferrin) – indicator of alcohol consumption (increase in CDT with daily alcohol consumption of more than circa 60-70 g for circa two weeks).
  • Sweat test (using pilocarpine iontophoresis for clinical detection of cystic fibrosis; the test is routinely performed during newborn screening; gold standard) [increased chloride ion content is found in the sweat of cystic fibrosis patients compared to healthy subjects]
  • Molecular genetic testing for:
    • Mutations (N34S and R65Q) in exon 3 of the SPINK1 gene.
    • PRSS1 gene in patients with a positive family history (one or two first-degree relatives with idiopathic chronic pancreatitis)
    • Molecular genetic testing – CFTR genetic mutation analysis (mutations delta F508, G542x, G551D, 621+1 (G>T), R553X, N1303K) in case of positive sweat test – in children with recurrent pancreatitis of unclear cause.
  • Parathyroid hormone
  • If infectious genesis is suspected.