Serum Enzymes and Inflammatory Mediators as Predictors of Severity in Acute Pancreatitis

Background: Acute pancreatitis (AP) is an inflammatory disorder of the pancreas with a wide clinical range from mild self-limiting disease to severe necrotizing forms associated with multiorgan failure. Early identification of severe cases is crucial to improve outcomes. Conventional biomarkers like serum amylase and lipase are diagnostic but limited in assessing severity. Novel inflammatory markers, including interleukin-10 (IL-10) and procalcitonin (PCT), have emerged as potential prognostic indicators.

Objectives: To evaluate and compare the diagnostic and prognostic utility of serum amylase, lipase, IL-10, and procalcitonin levels among healthy individuals, patients with mild acute pancreatitis, and those with severe acute pancreatitis.

Methods: A hospital-based, observational case–control study was carried out at J.L.N. Medical College, Ajmer, including 330 participants divided equally into three groups: healthy controls (n=110), mild AP (n=110), and severe AP (n=110), classified according to the Revised Atlanta Criteria. Serum amylase and lipase were determined using enzymatic assays, IL-10 by ELISA, and PCT by chemiluminescent assay. Statistical analyses included ANOVA, t-tests, correlation, and post-hoc comparisons, with significance set at p<0.001.

Results: Serum amylase and lipase levels were markedly increased in both mild and severe AP groups relative to controls (p<0.001), with significantly higher values in severe cases (amylase: 1482.44 ± 437.04 U/L; lipase: 879.65 ± 52.92 U/L). IL-10 levels showed a progressive decline with disease severity (controls: 6.06 ± 0.31 pg/mL; severe AP: 3.91 ± 0.31 pg/mL; p<0.001). Procalcitonin levels rose proportionally with disease progression (controls: 0.33 ± 0.06 ng/mL; severe AP: 2.90 ± 0.92 ng/mL; p<0.001). These findings underscore the prognostic significance of IL-10 and PCT in differentiating mild from severe disease.

Conclusion: While serum amylase and lipase remain reliable diagnostic tools for acute pancreatitis, their prognostic value is limited. Reduced IL-10 and elevated procalcitonin levels are strongly associated with severe forms of the disease, suggesting their combined use may enhance early risk stratification and management of acute pancreatitis.