The relative sensitivity of serum lipase versus amylase for radiological image-positive pancreatitis
Bibliographic record
Abstract
Due to the absence of a 'gold standard' test for the diagnosis of pancreatitis, the sensitivities of pancreatic enzyme tests for pancreatitis are still debated. We compared the relative sensitivities of lipase and amylase at their upper limit of normal values for image-positive pancreatitis in a large consecutive series of patients who had simultaneous tests of amylase and lipase. Consecutive patients with a clinical diagnosis of pancreatitis defined by constant epigastric pain and elevation of the amylase or lipase to greater than 106 U/l or 59 U/l, respectively, were imaged by abdominal sonography or computerized axial tomography (CAT) scan. All included patients had positive radiological evidence of acute pancreatitis. The pancreas was visualized in 399/473 (84%) patients with suspected pancreatitis and 127/399 (38%) had radiological evidence of pancreatitis. Elevation of the lipase to >59 U/l detected 127/127 cases of image-positive pancreatitis, while elevation of the amylase to >106 U/l detected 113/127 cases (88% sensitive (0.82–0.94)). All cases of acute biliary pancreatitis were detected by both the lipase and amylase. The amylase missed 14 of 65 patients with nonbiliary etiologies of pancreatitis. Four of these were alcoholics. Our study shows a high degree of relative sensitivity of the lipase compared with amylase for pancreatic injury that is demonstrable on CAT or sonographic imaging. Our findings demonstrate a relative lack of sensitivity of amylase for nonbiliary etiologies of pancreatitis. We recognize that the absolute sensitivity of lipase for image-positive pancreatitis cannot be determined by this retrospective methodology that required elevation of one marker for inclusion.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.069 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.001 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".