Amylase In Patients Research Articles

Effect of Some Demographic Changes on Some Oral Immune Aspects in Periodontal Disease Patients

Periodontal diseases (PD) are worldwide diseases of humans either in childhood or adults. The present study aimed to find the correlation between some demographic and saliva immunological factors including the determination of saliva TLR-2, IL6, CRP, and α- amylase in patients with periodontal diseases. For this purpose, 60 patients out of which 33were males and 27 were females participated in this study from different Dental treatment Centers (Amirya Specialized Dental Center and Almaamon Specialized Dental Center ) in Baghdad/ Iraq, for the period starting from November / 2021 to February / 2022. Both age ranges for patients and control are (13-70) years, and patients’ mean ages are 34.29±15.01. Additionally, the control specimens were collected randomly from 40 apparently healthy people. The results of some demographic parameters revealed that there were no significant differences between males 55.0% and females 45.0% in PD. As well as, periodontal disease is not directly associated with rising smoking among patients or non-smoking individuals with PD. Acidic oral pH is not significantly found in most PD patients 47.1% and control subjects 66.7%, simultaneously, smoking may not be associated with acidic oral saliva directly. Other tests in concern with PD patients are considered to be very important in many aspects, firstly interleukin (IL6) recorded high non-significant mean occurrence results in both patients’ 50161± 63869 ng/l and control 52087 ± 62756 ng/l groups. Secondly, C-reactive protein (CRP) as IL6, recorded a non-significant increase in the saliva of PD patients at 0.537 ± 0.607 mg/l and control at 0.607 ± 0.266 mg/l. Toll-like receptor-2 (TLR-2) is the third immune parameter measured in saliva which recorded significant differences between PD patients 7.384 ± 4.031 ng/ml and control 5.313 ± 3.106 ng/ml, simultaneously. Then the fourth saliva parameter is α-amylase the results recorded a significant difference between PD patients 2.444 ± 1.870 ng/ml and control 1.041 ± 1.044 ng/ml. Also, the results showed that there was no correlation between measured demographic and immunological parameters.

Estimation of Salivary pH, Salivary Amylase in Patients with Oral cancer, Pre and Postoperatively -A Comparative Study

Introduction: Saliva has been studied for so long and it almost stands hand in hand with other diagnostic tests which could possibly replace blood in disease diagnosis and monitoring. Salivary pH and salivary amylase levels are an excellent predictor of the oral environment and salivary gland health, hence, estimating these characteristics is a reasonable method of assessing a patient’s risk of disease onset, severity, and prognosis.
 Aims: The aim of the study was to compare salivary pH, salivary amylase, pre and postoperatively in oral cancer patients.
 Study Design: The study is a comparative study.
 Place and Duration of Study: The study was conducted in the Department of Oral and Maxillofacial Surgery, Yenepoya Dental College, Mangalore between October 2020 and October 2021.
 Methodology: We included 24 patients (20 men, 4 women; age range 40-70 years) who were histopathologically confirmed oral cancer patients. For every patient saliva was collected preoperatively on the day of surgery and postoperatively 5 days after the surgery. Salivary pH was measured using pH meter and salivary amylase was measured using color spectrophotometry.
 Results: A significant increase in salivary pH was observed post operatively (7.07) as compared to the preoperative values (6.63). A significant decrease in salivary amylase value was observed post operatively (147.13) as compared to preoperative values(147.88) both salivary pH and salivary amylase values were statistically significant.
 Conclusion: There was an increase in salivary pH postoperatively and decrease in salivary amylase levels in postoperatively. However, an increase in sample size with further research should be carried out to further authenticate the study.

Acute pancreatitis in a COVID-19 patient in Brazil: a case report

BackgroundThe consequences of the coronavirus disease 2019 pandemic have already exceeded 10 million infected and more than 560,000 deaths worldwide since its inception. Currently, it is known that the disease affects mainly the respiratory system; however, recent studies have shown an increase in the number of patients with manifestations in other systems, including gastrointestinal manifestations. There is a lack of literature regarding the development of acute pancreatitis as a complication of coronavirus disease 2019.Case reportWe report a case of acute pancreatitis in a white male patient with coronavirus disease 2019. A 35-year-old man (body mass index 31.5) had acute epigastric pain radiating to his back, dyspnea, nausea, and vomiting for 2 days. The patient was diagnosed with severe acute pancreatitis (AP)-APACHE II: 5, SOFA: 3, Marshall: 0; then he was transferred from ED to the semi-intensive care unit. He tested positive for severe acute respiratory syndrome coronavirus 2 on reverse transcription-polymerase chain reaction, and his chest computed tomography findings were compatible with coronavirus disease 2019. Treatment was based on bowel rest, fluid resuscitation, analgesia, and empiric antibiotic therapy. At day 12, with resolution of abdominal pain and improvement of the respiratory condition, the patient was discharged.ConclusionSince there is still limited evidence of pancreatic involvement in severe acute respiratory syndrome coronavirus 2 infection, no definite conclusion can be made. Given the lack of other etiology, we consider the possibility that the patient’s acute pancreatitis could be secondary to coronavirus disease 2019 infection, and we suggest investigation of pancreas-specific plasma amylase in patients with coronavirus disease 2019 and abdominal pain.

English

BACKGROUND Organophosphorus (OP) compounds are insecticides which are widely used in agriculture. Acute organophosphorus poisoning is one of the important causes of morbidity and mortality in developing countries like India. Considering financial burden / availability of tests, we need cheap and easily measurable biomarkers for predicting prognosis / complications in a limited resource country, like India. We intend to correlate the levels of serum amylase in patients admitted with acute organophosphorus poisoning for predicting the severity of acute OP poisoning and also to correlate serum amylase association with respiratory failure. METHODS This was a prospective observational study. Total of 94 patients of OP poisoning admitted to KIMS Hospital, Hubballi between January 1st 2017 and December 31th 2017 were studied. Detailed history, clinical examination, and lab investigations like pseudocholinesterase, serum amylase and other relevant investigations were carried out. Peradeniya OP poisoning scale was applied to all the study subjects and the severity of OP poisoning was graded as mild, moderate, severe. Data obtained was analysed by different statistical methods. RESULTS OP poisoning was more common in adults of age group between 20 – 30 years, Incidence was more in male patients and mortality rate was 12.8 %. Mean values of serum amylase negatively correlate with pseudocholinesterase levels and it was statistically significant. Correlation between the severity of OP poisoning (based on Peradeniya score) and biochemical parameters like pseudocholinesterase, serum amylase was statistically significant. CONCLUSIONS The correlation between the severity of OP poisoning and biochemical parameter– serum amylase, was statistically significant and it was useful in predicting the development of respiratory failure. Pseudocholinesterase and serum amylase were also useful to predict the outcome of the patient. KEYWORDS Amylase, Organophosphorus Poisoning, Pseudocholinesterase, Peradeniya Score

Raised serum amylase in patients with COVID-19 may not be associated with pancreatitis

A high incidence of pancreatitis in COVID-19 has been reported. Although a high proportion of critically unwell patients with COVID-19 have raised serum amylase levels, this does not necessarily reflect acute pancreatitis or a clinically important pancreatic injury.

An Emerging Clinical Form of Acute Pancreatitis in Covid-19

Background: As the global severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic continues, new clinical forms of the disease continue to emerge. While the coronavirus is responsible for gastrointestinal symptoms and acute hepatitis, researchers at the Royal University Hospital of Liverpool say they have identified cases of COVID-19-linked pancreatitis in young patients with COVID-19. Objectives: To establish influence of concomitant COVID-19 on clinical presentation and treatment strategy of patients with AP. Methods: This is a case report of pediatric patient admitted to a Pediatric Gastroenterology Unit, A. Harouchi Hospital, CHU Ibn Rochd, Casablanca, Morocco in October 2020 during the COVID-19 pandemic. Results: We report the observation of a 16-year-old girl, who received symptomatic outpatient treatment for influenza-like illness with a fever of 38.5°C before rapidly evolving in 1 week to stage E pancreatitis, where a SARS-COV2 IgG and IgM viral serology was requested coming back positive with a negative nasopharyngeal PCR covid. Conclusion: In conclusion, pancreatitis caused by SARS-CoV-2 is a real but rare entity; in fact COVID-19 can present as pancreatitis. This case highlights acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain. This diagnosis is important for adequate treatment and better management of systemic repercussions, such as SIRS, decreasing SARS-CoV-2 mortality.

Coronavirus Disease-19 (COVID-19) associated with severe acute pancreatitis: Case report on three family members

Background/ObjectivesAbdominal pain is one of the known symptoms associated with coronavirus disease 2019. Little is known about the development of acute pancreatitis as a complication of severe acute respiratory syndrome coronavirus 2 infection. This case report describes the presentation of acute pancreatitis in two of three family members with severe COVID-19 infection. MethodsData were collected from three family members admitted with COVID-19 to the intensive care unit in March 2020. This study was reviewed and approved by the local data and ethics committee (31-1521-253). ResultsTwo of the three family members were diagnosed with acute pancreatitis associated with SARS-CoV-2. Other causes of acute pancreatitis were excluded for both patients (including alcohol, biliary obstruction/gall stones, drugs, trauma, hypertriglyceridemia, hypercalcemia, and hypotension). ConclusionsThese cases highlight acute pancreatitis as a complication associated with COVID-19 and underlines the importance of measuring pancreas-specific plasma amylase in patients with COVID-19 and abdominal pain.

Clinical significance of serum amylase and glucose level in organophosphorus poisoning

Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism.
 Materials and Method: This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared.
 Results: Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis.
 Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

Study of serum amylase in patients with infective hepatitis and its comparison in patients without infective hepatitis

Study of serum amylase in patients with infective hepatitis and its comparison in patients without infective hepatitis - IJCBR- Print ISSN No: - 2394-6369 Online ISSN No:- 2394-6377 Article DOI No:- 10.18231/j.ijcbr.2019.035, International Journal of Clinical Biochemistry and Research-Int J Clin Biochem Res

Salivary Alpha-amylase Activity Level in ST-segment Elevation Myocardial Infarction Patients

Background and Objective: Sudden death is the main cause of mortality and disability in patients with coronary artery disease or myocardial infarction. The aim of this study was to evaluate the activity level of salivary alpha-amylase to predict malignant ventricular arrhythmias in ST-segment elevation myocardial infarction (STEMI) patients.
 Materials and Methods: In this analytical cross-sectional study, 42 patients with STEMI who referred to Imam Reza Hospital participated. First, salivary amylase was taken from all STEMI patients and then these patients were divided into two groups of patients with malignant ventricular arrhythmia or without malignant ventricular arrhythmia during 72 hours.
 Results: A total of 42 patients were included in the study out of which 30 (71.4%) were females and 12 (28.6%) males. The average salivary amylase in patients was 118/41 ± 96/87. There was no significant difference in the frequency of diabetes, blood pressure, blood lipids, ischemic heart disease, and involvement severity in both groups with arrhythmia and lack of arrhythmias (P> 0.05). Also there was no significant difference in systolic and diastolic blood pressure, respiratory rate, heart rate, oxygen saturation, blood glucose, temperature and severity of infarction (P> 0.05). However, the two groups were different in terms of salivary amylase levels. Salivary amylase levels were significantly higher in arrhythmic group than in the non-arrhythmic group (P< 0.001).
 Conclusions: Our result shows that there is a difference in the concentrations of salivary Alpha-amylase activity level in with and without ventricular arrhythmias groups.

Serum Amylase in Patients of Chronic Kidney Disease Stage Three to Stage Five

Introduction: Chronic Kidney Disease (CKD) is a progressive loss in renal function over period of many months or years. As compared to the past decades, the number of kidney diseases leading to end CKD is increasing in Nepal. The disease is associated with the decreased glomerular filtration rate (GFR). There is decline in nephron function and number generally quantitated as reduction in glomerular filtration rate. As the GFR declines, there is accumulation of metabolic end products excreted by Kidney. Chronic kidney disease is identified by blood tests, creatinine and urea are two such substances routinely measured. Serum amylase is a pancreatic digestive enzyme that normally acts extracellular to cleave starch into smaller carbohydrate groups and, finally, into monosaccharide's. It is produced by 40-45% from the pancreas and (45%) reabsorbed by tubular cells. Elevations in serum total amylase among patients with CKD is due to impaired renal clearance and seen mostly when the creatinine clearance is below 50 ml/min. Several studies have been reported on this but there are no studies that have been done so far in Nepalese context.Objectives: This study is designed to correlate serum amylase with CKD stage three to stage five in patients of chronic renal disease irrespective of hemodialysis and prevalence of risk factors of CKD and different factors that may affect the level of serum amylase in patients presenting to Bir Hospital Nephrology department, Nepal.Methods: The study was a cross-sectional, observational, descriptive, hospital based carried out in Nephrology Unit of Bir hospital both inpatient or outpatient irrespective of hemodialysis from March 2014 to March 2015. Patients with increased serum amylase due to acute Pancreatitis, Mumps, Intestinal Obstruction, Peptic Ulcer, Cancer, other than renal cause were excluded. The results were analyzed using SPSS version 11 and Microsoft Excel by correlation coefficient. Result: Present study shows that among 126 patients, the prevalence of age group was from 15 years to 78 years with majority being male. The serum amylase levels were significantly higher in Chronic Kidney Disease Stage V with significant p-value. At 80-100 Serum Amylase level had strong correlation of 0.504 for CKD III stage and significant at 10 percent level. The correlation between CKD IV at 80-100 was significant at 10 percent but weak of 0.189. Whereas, CKD V was highly significant but negative at more than 161 Serum Amylase.Conclusion: From the study it was concluded that in Chronic Kidney Disease, Serum amylase was found to be higher as the eGFR decreases. BJHS 2018;3(2)6:403-407.

Effect of Atorvastatin on Serum Levels of Lipase and Amylase in Patients of Hyperlipidemia

Effect of Atorvastatin on Serum Levels of Lipase and Amylase in Patients of Hyperlipidemia

Salivary Amylase as a Marker of Salivary Gland Function in Patients Undergoing Radiotherapy for Oral Cancer.

The aim of this study was to evaluate salivary amylase in patients with primary oral cancer undergoing radiotherapy as the main modality of treatment. The study was conducted on ten histologically proven cases of oral cancer undergoing radiotherapy. Stimulated whole saliva was collected at three stages of radiotherapy-0, 3, and 6 weeks. Salivary amylase was estimated using Henry-Chiamori method and comparison was made with appropriate age- and gender-matched controls. Salivary amylase levels showed significant decrease in healthy subjects when compared to oral cancer patients (P < 0.001). The latter group also showed changing trend with initial decrease from 0 to 3 weeks followed by increase from 3 to 6 weeks following radiotherapy (P < 0.0528). The trend in changes in the levels of salivary amylase could be used as a surrogate marker of salivary gland function in patients with oral cancer undergoing radiotherapy as primary treatment.

The use of serum Amylase as a predictive factor for mortality in Perforated Duodenal Ulcer

serum amylase occurs in cases of perforated peptic ulcer partly as a result of increase leakage of pancreatic enzymes rich fluid from the perforation site with subsequent absorption by peritoneal lymphatics &amp; partly due to damage of pancreases by digestive enzymes that spilled through the perforation.Objectives: To determine the significance of abnormally high level of serum amylase in patients undergone operation for PDU, to study the factors that tend to bring about elevated serum amylase level in these patients.Patients and Methods: A prospective study of 250 patients with perforated duodenal ulcer (PDU) at al kindy teaching hospital, Baghdad, Iraq from June 2008- august 2010. patients were examined clinically and investigated by blood test, chest x- ray, plain X- ray of the abdomen. &amp;ultrasonography (U/S). Resuscitation by intravenous fluid, antibiotic were done. Explorative laparotomy performed for all patients, repair of perforation done by simple omental patch. Data regarding site, size of perforation, amount of spilled fluid and operative finding were recorded.Results: Two hundred fifty patients included in this study with proven PDU, 222 (88.8 %) were male and 28 (11.2 %) were female, male to female ratio is 8 :1. The mean age was 38 years, ranging from 22-70 years. The over all mortality was 14.4%. In 210 patients( 84%), the serum amylase was within normal range, the mortality in this group was 10 %. The other 21 patients (16%) had level of 200 or above, the mortality in this group was 37.5 %. Mortality was 5 % in cases with mild intra peritoneal fluid spillage, 9% in moderate, 25% in large amount &amp; 39 in massive intra peritoneal spillage. The size of perforation has prognostic significance, for the larger the perforation, the higher the mortality.Conclusions: Limiting surgical delay in patients with PDU seems to be of paramount importance in reducing the mortality in these patients. In patients with PPD, the high serum amylase the high mortalityrate.

Evaluation of Biochemical Markers Serum Amylase and Serum Lipase for the Assessment of Pancreatic Exocrine Function in Diabetes Mellitus.

Diabetes mellitus (DM), a metabolic disorder characterized by hyperglycaemia, associated with deficiency or resistance to insulin indicates endocrinal abnormality of the pancreas. Amylase and lipase are enzymes secreted by the exocrine portion of the pancreas. Endocrinal derangement observed in diabetes may interfere with the exocrine function of the pancreas. To estimate the levels of fasting blood sugar, serum lipase, serum amylase in patients of type 1 and type 2 DM. Than comparing them with healthy controls and to study the effect of type 1 and type 2 DM on pancreatic exocrine function using serum levels of amylase and lipase as biochemical marker. This study was conducted at GMERS Medical College and Hospital from Dec 2015 to July 2016. Thirty patients of type 1 DM and 30 patients of type 2 DM, who were already diagnosed and taking treatment, were included in this study. A total number of 30 apparently healthy individuals were recruited as the control group in our study. Fasting venous blood samples were collected from the cases as well as the controls and they were analysed by using semi auto analyser for blood glucose, serum amylase and serum lipase. The results were analysed statistically by using SPSS software. Values were expressed as means ± SD. We found statistically significant (p<0.01) low values for serum amylase and serum lipase in patients with type 1 and type 2 DM as compared to healthy controls. Fasting blood sugar was significantly higher in cases as compared to controls. We found negative correlation of fasting blood sugar level with serum amylase and serum lipase and positive correlation of serum amylase with serum lipase in both type 1 and type 2 DM. Our study clearly demonstrated that in type 1 and type 2 DM, there was increase in fasting blood sugar with decrease in serum amylase and serum lipase which signifies the derangement of endocrine-exocrine axis of the pancreas. Serum amylase and serum lipase can be used as biochemical markers for assessment of pancreatic exocrine function.

استعمال انزيم الاميليز كعامل لتحديد نسبة الوفيات لمرضى قرحة الاثنى عشر المنفجرة

&nbsp;الخلفية :&nbsp;&nbsp;ان ارتفاع انزيم الاميليز في مصل الدم يحصل في اغلب الحالات لدى مرضى قرحة الاثنى عشر المفجورة . وهذا الارتفاع يحصل بسبب تسرب بعض عصارات البنكرياس من جهة الثقب مع امتصاص هذه السوائل من قبل الغشاء البريتوني من جهة ، ومن جهة ثانية بسبب اعتلال البنكرياس الناتج من نضوح الانزيمات الهاضمة من الثقب . الهدف من الدراسة ، ملاحضة ارتفاع انزيم الاميليز في مصل مرضى اجريت لهم عملية معالجة قرحة الاثني عشر المفجورة ولبيان العوامل التي ادت الى ارتفاع هذا الانزيم لهؤلاء المرضى . المرضى وطرق العمل: اخذت العينات من 250 مريض ( 222 رجل و 28 امرأة ) ممن يعانون قرحة الاثني عشر المفجورة كانت اعمارهم تتراوح بين 22-70 سنة ( المعدل 38 سنة ) ، الراقدين في مستشفى الكندي التعليمي – بغداد –العراق- في الفترة بين حزيران 2008 وآب 2010 . تم اجراء الفحوصات بأخذ عينات الدم لاجراء تحليل انزيم الاميليز مع اجراء فحوصات سريرية واشعة لمنطقة الصدر واخذ اشعة فوق الصوتية لمنطقة البطن .وتم تحديد موضع وحجم الثقب وحجم السائل الناضح مع نتائج العملية العلاجية . النتائج : &nbsp;210 من المرضى كان انزيم الاميليز لديهم طبيعي ونسبة الوفيات كانت 10% لهذه المجموعة . وكلما زاد تركيز انزيم الاميليز&nbsp; ، ازداد معدل الوفيات . الاستنتاج :&nbsp;هناك علاقة قوية تربط حجم القرحة مع كمية انزيم الاميليز الناضح ونسبة الوفيات بهذا المرض . وان الاسراع في اجراء الجراحة العلاجية لقرحة الاثني عشر المنفجرة له اهمية كبيرة في التقليل من نسب الوفيات بسبب هذا المرض .

Perioperative Anxiety, Pain, and Salivary Amylase in Patients Undergoing Pancreatic Surgery

Although many reports on perioperative anxiety and stress in patients have been published, very few have longitudinally focused on the acute phase immediately after surgery. We aimed to investigate the actual levels of perioperative stress experienced by patients undergoing pancreatic surgery in the acute phase. We conducted a survey of 29 patients undergoing pancreatic surgery. These patients were assessed five times: once preoperatively and on postoperative days 1, 3, 5, and 7. The measurement indices used were the State-Trait Anxiety Inventory (STAI), the Visual Analog Scale (VAS) for pain, and salivary amylase activity. No significant difference in the STAI scores was observed throughout the survey period. In other words, the patients did suffer persistent, moderate anxiety. The VAS scores clearly peaked on postoperative day 1 and dropped thereafter. Salivary amylase activity peaked on postoperative day 3 and then decreased. On postoperative day 7, the VAS scores of patients who underwent open surgery were significantly higher than those of patients who underwent laparoscopic surgery; the patients undergoing open surgery also complained of prolonged pain. Significantly higher salivary amylase activity on postoperative day 3 indicated that the open surgery patients experienced greater stress levels. The laparoscopic group experienced less stress than the open group. The results of the present evaluation of anxiety, pain, and stress experienced by patients may provide a very good reference for perioperative care in pancreatic surgery.

Elevated serum amylase in patients with chronic pancreatitis: Acute attack or macroamylasemia?

Background and aimAsymptomatic patients with chronic pancreatitis not infrequently have elevated concentrations of amylase, even though detailed examination reveals no indication of an acute exacerbation. MethodsOne hundred and eighty-six consecutive patients with chronic pancreatitis were examined clinically and, if indicated, by ultrasonography and computed tomography. In addition, all patients underwent determination of serum amylase and serum lipase as well as amylase/creatinine clearance, followed as required by a polyethylene glycol test and/or chromatography to demonstrate macroamylase. ResultsTwenty (11%) of the 186 patients had macroamylasemia, and 15 of these 20 had hyperamylasemia. In the remaining five cases the serum amylase levels were within the normal range. ConclusionsPatients with asymptomatic chronic pancreatitis and hyperamylasemia should first be investigated for macroamylasemia, before initiating any costly or complex procedures in the attempt to demonstrate a clinically silent or only mildly symptomatic attack of their disease.

Characterisation of faecal protease activity in irritable bowel syndrome with diarrhoea: origin and effect of gut transit

ObjectivesFaecal serine proteases (FSPs) may play a role in irritable bowel syndrome with diarrhoea (IBS-D), but their origin is unclear. We aimed to structurally characterise them and define the impact...

Bronchoalveolar Lavage Amylase Is Associated With Risk Factors for Aspiration and Predicts Bacterial Pneumonia*

Aspiration of oropharyngeal or gastric contents into the respiratory tract leads to a spectrum of disorders with high morbidity. Aspiration is a diagnostic dilemma, because clinical characteristics and diagnostic tests are not effective predicting or confirming aspiration. We sought to determine whether α-amylase, a protein secreted by salivary glands and the pancreas, is elevated in bronchoalveolar lavage specimens in patients with clinical risk factors for aspiration and whether bronchoalveolar lavage amylase predicts bacterial pneumonia. Retrospective analysis. Five adult ICUs at a tertiary care urban medical center. Mechanically ventilated patients who underwent either bronchoscopic or nonbronchoscopic bronchoalveolar lavage within 72 hrs of endotracheal intubation between August 1, 2008 and June 30, 2010. A total of 296 bronchoalveolar lavage amylase results from 280 patients were included in the analysis, and 155 bronchoalveolar lavage amylase specimens were obtained from patients with at least one predefined preintubation risk factor (altered consciousness, swallowing dysfunction, difficult intubation, peri-intubation vomiting, or cardiac arrest). Bronchoalveolar lavage amylase concentration increased as the number of preintubation risk factors increased (p < 0.001). In addition, bronchoalveolar lavage amylase was elevated in patients with bacterial pneumonia (cfu/mL ≥ 10) (p < 0.001). The area under the receiver operator curve for the ability of bronchoalveolar lavage amylase to differentiate between positive and negative bronchoalveolar lavage culture was 0.67 (95% confidence interval, 0.60-0.75). The lower 95% confidence interval for bronchoalveolar lavage amylase in patients with at least one preintubation risk factor for aspiration was 125.9 units/L. In multivariate analysis, bronchoalveolar lavage amylase < 125 units/L was associated with significantly lower odds of bacterial pneumonia (odds ratio 0.39, 95% confidence interval 0.21-0.71, p = 0.002). Elevated bronchoalveolar lavage amylase is associated with risk factors for aspiration and may predict bacterial pneumonia. Bronchoalveolar lavage amylase may be useful as an early screening tool to guide management of patients suspected of aspiration.