Prospective follow-up of the Patients with Hyperamylasemia after Cardiac Surgery

Overview

Objective:
Hyperamylasemia is reported in 30–70% of cardiac surgery patients. The exact cause of elevated serum levels ofamylase remains unclear. The goal of our study was to find out the possible cause of amylase elevation and evaluate theinfluence of increased levels of serum amylase on the postoperative course and clinical outcome of 110 cardiac surgicalpatients.Design: Prospective study.Setting: Cardiac Surgery Department, Prague General Hospital, 1st Medical Faculty of Charles University, Prague, the CzechRepublic.Material and methods: The cohort of 110 randomly selected patients who underwent cardiac surgery at our institution wasstudied prospectively. Serial blood and urine samples were obtained on the 1st and 2nd morning after the operation.Pancreatic isoamylase, creatinine, the fractional clearence of pancreatic isoamylase (in relation to creatinine clearence)were measured. To preclude an important pancreatic cellular injury we used the semiquantitative urinary trypsinogen-2dipstick test. Postoperatively we studied a clinical course of illness, start of feeding by oral route and time to discharge frompostoperative ICU.Results: 22 out of 110 patients (20%) had at least one serum sample with elevated pancreatic isoamylase concentration.Weobserved no acute pancreatitis in our patients. Preoperative hyperamylasemia and perioperative hemodynamic insult wereidentified as independent predictors of postoperative hyperamylasemia leading probably to splanchnic hypoperfusion.Conclusion: Early elevation of pancreatic isoamylase after cardiac surgery procedure probably could not be interpreted asa sign of pancreatic cells injury and does not affect mortality or morbidity.

Key words:
amylases – pancreatitis – trypsinogen – cardiac surgery