ELEVATION OF PANCREATIC ENZYMES IN HEAD INJURY PATIENTS ADMITTED IN INTENSIVE CARE UNIT-A PROSPECTIVE STUDY.
Background: Elevated amylase and lipase are commonly seen in patients admitted in intensive care unit without a previously recognised pancreatic illness, constituting a diagnostic and therapeutic challenge. The aim of the study is to find the incidence, to assess and evaluate the predictive factors in head trauma induced increase of serum amylase and lipase levels.
Methods: We conducted a prospective observational study. All adult patients admitted with head trauma were eligible for our study. On admission serum amylase and lipase were measured. Patients with and without elevated pancreatic enzyme levels were compared for age, sex, initial GCS score, ICU stay days, serum amylase and lipase levels, creatinine, C Reactive Protein and hemoglobin. We also collected data on vital signs and other biochemical findings. Statistical analyses: Chi-square test and students t test with statistical significance p<0.05.
Results: Forty eight patients were included. Median (quartiles) of age was 52[32-68].Eleven patients (23%) had increased serum amylase and lipase levels. Diabetes mellitus (p=0.027), serum creatinine level (p=0.020), Haemoglobin level(p=0.039) were identified as independent factors predicting increased pancreatic enzymes. Hence these factors were significantly associated with elevated pancreatic levels and were not associated with sex, age, initial GCS score, ICU stay days, hypotension.
Conclusion: Increase of pancreatic enzymes is commonly seen in patients with head trauma. Diabetes and impaired renal function are predictive factors of elevated pancreatic enzymes. Patients with increased pancreatic enzymes should be further investigated to rule out any intra abdominal pathology by doing USG abdomen, CT abdomen and repeated clinical examination so that the morbidity and mortality due to associated abdominal injury in patients with head injury can be minimised.
Keywords: Amylase, Lipase, head trauma, intensive care unit.