[Relationship between changes of increased amylase or lipase levels and pancreas injury in critically ill children].

OBJECTIVE: To observe the occurrence rate of elevated serum amylase and lipase in critically ill children, to explore the relationship between elevated pancreatic enzymes and pancreatic injury, and the effect of elevated pancreatic enzymes on state of illness and the prognosis.

METHOD: The data of cases treated in pediatric intensive care unit(ICU) of 17 children's hospitals were collected prospectively from January 2012 to March 2014 according to the inclusion and exclusion criteria.The cases were divided into three groups: the control group (amylase or lipase were normal), mildly elevated group (1 time < increase of serum amylase or <3 times increase of lipase), highly elevated group (serum amylase or lipase increased >3 times). Clinical manifestations, pancreatic ultrasound, biochemical indicators, state of organ damage and failure, mechanical ventilation, severity of sepsis, mortality rate and survival were compared among different groups using t test, analysis of variance, chi-square test or non-parametric test.The risk factors of elevated amylase or lipase were analyzed by Logistic regression analysis.

RESULT: (1) The 3 380 cases (2 140 boys and 1 240 girls) were divided into three groups: normal group (2 607 cases), mildly elevated group (569 cases), highly elevated group (204 cases). The occurrence rate of elevated serum amylase and lipase in critically ill children was 22.87% (773/3 380). (2) The differences of occurrence rates of hypotension, vomiting, abdominal tenderness, muscle tension, positive peritoneal irritation, decreased bowel sounds, liver enlargement, seizures and unconsciousness among the three groups were statistically significant(χ(2)=32.264, 12.071, 13.959, 7.979, 13.774, 12.459, 9.443, 40.805, 99.183, P<0.05 for all these comparisons). (3) The rates of abnormal pancreatic ultrasound in control group, mildly elevated group and highly elevated group were 0.90%(4/443), 14.06%(9/64), 20.83%(5/24)(χ(2)=52.925, P=0.000). (4) The differences of occurrence rates of BE, white blood cell count, procalcitonin, calcium, alanine aminotransferase, aspartate aminotransferase, creatinine, urea nitrogen, lactate dehydrogenase, CKMB among the three groups were statistically significant(χ(2)=59.485, 27.634, 125.564, 102.258, 10.175, 27.338, 80.616, 140.521, 72.830, 72.136, P all <0.05). (5) The differences of occurrence rates of myocardial damage, liver injury, kidney injury, acute respiratory distress syndrome, intracranial hypertension syndrome, stress ulcer, coagulation disorders, circulatory dysfunction, severe sepsis, multiple organ dysfunction (MODS) among the three groups were statistically significant(χ(2)=8.826, 17.864, 49.061, 96.221, 106.918, 80.559, 30.355, 99.183, 196.412, 133.887, 154.239, 9.206, P all <0.01). (6) The median of survival table of children with normal pancreas was 75 days, the median of survival table of children with elevated amylase or lipase was 24 days.(7) The risk factors of elevated amylase or lipase were age, convulsions, consciousness, BE, PCT, calcium, mechanical ventilation, severe sepsis and MODS(OR=1.155, 1.491, 2.237, 0.949, 0.604, 1.008, 0.660, 1.907, 0.836, P all<0.05).

CONCLUSION: The occurrence rate of hyperamylasemia or high lipase levels in critically ill children were lower than adults, elevated pancreatic enzymes was accompanied by the progression of critical illness, pancreatic enzymes elevated probably due to pancreatic damage, which positively correlated with severity of the disease and the prognosis.