A Comparison of Serum Lipase Levels and Clinical Outcome Trends in Hospitalized Pediatric Patients With Acute Pancreatitis: A Single-Center Retrospective Study.

Background Serum lipase is widely used for the diagnosis of acute pancreatitis (AP) in pediatric patients; however, its prognostic value remains unclear. Despite limited evidence supporting serial monitoring, lipase levels are frequently trended during hospitalization. This study aimed to evaluate whether trending serum lipase levels are associated with improved clinical outcomes in children hospitalized with AP. Methodology We conducted a single-center retrospective chart review of pediatric patients (0-19 years) admitted with AP at Children's Hospital & Medical Center between January 1, 2021, and December 31, 2022. Diagnosis was based on the INSPPIRE criteria. Patients were categorized into the following two groups: those who had serum lipase levels trended after diagnosis and those who did not. Clinical outcomes, including persistence of abdominal pain, nausea, and/or vomiting at 48 and 96 hours; length of stay (LOS); type of intravenous fluids administered; analgesic use; associated risk factors; and cost of laboratory testing, were analyzed. Results A total of 65 patients met the inclusion criteria. Of these, 77% had serial lipase levels measured. There was no statistically significant difference in symptom persistence at 48 hours (63.8% in trended vs. 78.6% in non-trended; p = 0.35) or at 96 hours (82.9% vs. 100%; p = 0.58). Patients in the trended group had a significantly longer median LOS (4.0 days) compared to the non-trended group (2.5 days) (p = 0.0129). The mean laboratory cost was higher in the trended group ($184.0) compared to the non-trended group ($66.0). No meaningful prognostic correlation was identified between serial lipase levels and clinical improvement. Conclusions Serial trending of serum lipase levels in hospitalized pediatric patients with AP does not provide prognostic value regarding symptom resolution and is associated with increased hospital LOS and higher healthcare costs. Lipase testing should be limited to diagnostic purposes rather than routine monitoring during hospitalization.