Systemic Inflammatory Response Syndrome and Disease Severity Prediction via Admission Serum Lipase–Amylase Ratio in Acute Alcoholic Pancreatitis: A Prospective Observational Study

Abstract

Background: Acute alcoholic pancreatitis (AAP) presents a significant clinical challenge because of its potential to induce systemic inflammatory response syndrome (SIRS), multi-organ dysfunction, and increased mortality. Early identification of high-risk patients at admission is essential for timely intervention and resource allocation. Conventional pancreatic biochemical markers, specifically serum amylase and lipase, have limited prognostic utility when considered individually.

Methods: A prospective observational study was conducted in the Department of General Surgery at Mandya Institute of Medical Sciences (MIMS), Mandya, from November 2024 to October 2025. Sixty adult patients admitted within 24 hours of symptom onset with confirmed AAP were enrolled through consecutive non-probability sampling. Baseline demographic, clinical, and laboratory parameters, including serum amylase and lipase, were evaluated at admission to calculate the lipase–amylase ratio (LAR). Patients were prospectively monitored for SIRS development and disease severity. Statistical analysis was performed using SPSS version 26.0; independent-samples t-test, Chi-square test, Fisher’s exact test, and receiver operating characteristic (ROC) curve analysis were used, with p<0.05 considered statistically significant.

Results: Among 60 patients, 53 (88.30%) were male and the mean age was 45.83±13.87 years. Abdominal pain was present in all patients (100.00%), vomiting in 38 (63.30%), and fever in 36 (60.00%). SIRS developed in 8 patients (13.30%), while 15 (25.00%) developed severe pancreatitis. Mean LAR was higher in patients with SIRS than in those without SIRS (3.73±2.75 vs. 2.35±1.98), but the difference was not statistically significant (p=0.086). Mean LAR was significantly higher in severe than non-severe pancreatitis (4.77±2.91 vs. 1.78±1.03; p<0.001). For prediction of severe disease, the reported sensitivity, specificity, PPV, NPV, and overall accuracy were 73.00%, 100.00%, 100.00%, 91.80%, and 93.00%, respectively.

Conclusion: Admission serum LAR showed a strong association with overall disease severity in AAP. Its performance for isolated early SIRS prediction was limited. An elevated LAR was associated with severe clinical outcomes and may serve as an adjunctive biochemical marker for early risk stratification.