Lipase in the Diagnosis of Acute Pancreatitis - How to Eliminate Unnecessary Testing

• Test Ordering Program

Julie McDowell:

Amylase testing has long been used as a diagnostic tool for pancreatitis, despite amylase levels not being a definitive indicator of pancreatitis. Lipase offers a more useful diagnostic result as its readings are a better indicator of inflammation of the pancreas. According to Dr. James Nichols, a member of the CAP Quality Practices Committee, who helped to lead the development of a new lipase test ordering module. As part of the CAP test ordering program, this new lipase test module provides information and resources for the pathologist to address unnecessary testing volumes in the laboratory while still providing effective patient care as Dr. Nichols will explain in this CAP Cast.

Dr. Nichols welcome. First, can you tell us a little bit about what prompted your interest in testing volumes for lipase and amylase?

Dr. James Nichols:

Sure. As a laboratorian and medical director, I've always been interested in laboratory test utilization, trying to steer clinicians to the most effective ordering practices and to prevent over utilization, which can increase cost of care to the hospital. So this is one of those examples where oftentimes lipase and amylase are ordered together when really all that is needed is lipase, particularly in the case of acute pancreatitis.

Julie McDowell:

How widespread would you say is misapplied testing for both lipase and amylase?

Dr. James Nichols:

I would say it's very frequent, and if you speak with most clinicians, while they're aware that lipase is more specific for the pancreas, they tend to have order sets already prepared that automatically order both amylase and lipase. So this is a good quality improvement project for residents and for laboratorians to tackle.

Julie McDowell:

When should the healthcare provider order lipase testing?

Dr. James Nichols:

Sure. Lipase is an enzyme that hydrolyzes triglycerides to glycerol and free fatty acids, and it's responsible for fat digestion. So in acute pancreatitis, it tends to rise higher than amylase levels because while both amylase and lipase are eliminated by the kidneys, lipase rises much faster and stays elevated in acute pancreatitis compared to amylase. So for patients who are presenting with a delay to the emergency room of say, more than 24 hours, lipase is going to be more specific for trying to diagnose pancreatitis.

Julie McDowell:

Well, thank you, Dr. Nichols for discussing this topic. Any final thoughts you would like to share?

Dr. James Nichols:

Yeah. I would say that this is a great project for residents. Residents who are training in pathology both CPE as well as APCP are required as part of their training to participate in a quality improvement project. And test utilization is a great opportunity to improve and collaborate with others outside the department. So this is an opportunity for residents to get involved with clinicians and their ordering practices and to try to prevent high cost in healthcare.

Julie McDowell:

For more information about this test ordering program, module lipase and the diagnosis of acute pancreatitis, please visit the member resources section of cap.org and click on test ordering program or search for the module title using the search function at the top of the cap.org homepage.

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