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Causes of increased and decreased lipase
Last reviewed: 04.07.2025
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In acute pancreatitis, the activity of lipase in the blood increases within a few hours after the onset of the disease, reaching a maximum (up to 200 times) after 12-24 hours, and remains elevated for 10-12 days. The prognosis of the disease is considered unfavorable if the activity of lipase in the blood increases by 10 times or more and does not decrease to 3-fold excess of the norm over the next few days. The diagnostic sensitivity of lipase in the blood serum in acute pancreatitis is 86%, specificity - 99%. Simultaneous determination of the activity of α-amylase (in the blood and urine) and lipase is the basis for diagnosing acute pancreatitis. An increase in both or one of the enzymes is detected in 98% of patients with acute pancreatitis.
Unlike amylase, lipase activity does not increase in mumps, ectopic pregnancy, lung cancer, or appendicitis. The edematous form of acute pancreatitis is usually not accompanied by an increase in lipase activity; fatty pancreatic necrosis is characterized by a marked increase in its activity, which lasts up to 2 weeks; and in hemorrhagic pancreatic necrosis, it increases (on average 3.5 times) briefly on the 3rd-5th day of the disease. In purulent pancreatitis, an increase in lipase activity in the blood is usually not detected. Sometimes an increase in lipase activity is detected in patients with pancreatic cancer, chronic pancreatitis, and in the presence of a cyst in the pancreas.
Serum lipase activity has high sensitivity, especially in relation to the diagnosis of acute alcoholic pancreatitis, while patients with obstruction of the biliary tract, major duodenal papilla and pancreatic ducts are characterized by high amylase activity. In this regard, to establish the etiology of acute pancreatitis, the lipase-amylase coefficient is sometimes calculated: the ratio of lipase activity to amylase activity in the blood serum. A lipase-amylase coefficient value higher than 2 allows diagnosing acute alcoholic pancreatitis (sensitivity - 91%, specificity - 76%). Only in patients with acute alcoholic pancreatitis can the coefficient be higher than 5.
Increased lipase activity in the blood may occur in bowel infarction, peritonitis, biliary colic. Increased lipase activity in the blood has been noted in the destruction of adipose tissue - bone fractures, soft tissue injuries, after operations, and breast cancer.
Hyperlipasemia in uremia and acute renal failure is a consequence of congestion in the pancreas.