Diagnostic and Prognostic Value of Serum Lactate Dehydrogenase and Amylase in Severe Acute Pancreatitis: A Clinical Biochemistry–Based Evaluation

Serum LDH and AMY as Biochemical Predictors of SAP

  • Jie Zheng The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
  • Jin Wang The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
  • Yinong Zhou The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
  • Tingting Yu The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People's Hospital
DOI: https://doi.org/10.5937/jomb0-63403
Keywords: Lactate dehydrogenase, amylase, biochemical markers, severe acute pancreatitis, prognosis, ROC analysis

Abstract


Summary

Background: Severe acute pancreatitis (SAP) is characterized by extensive acinar-cell injury, metabolic dysregulation, and systemic inflammatory activation. Reliable biochemical markers for early risk stratification remain limited. Lactate dehydrogenase (LDH) and amylase (AMY), routinely measured enzymes reflecting cellular damage and pancreatic exocrine dysfunction, may provide prognostic value. To evaluate the diagnostic performance of serum LDH and AMY in identifying SAP and predicting short-term outcomes.

Methods: This retrospective study included 200 patients with acute pancreatitis. Serum LDH and AMY were measured on admission using standardized clinical chemistry assays with internal quality control. Patients were categorized as MAP, MSAP, or SAP, and SAP cases were further stratified into good and poor 2-week prognosis groups. Logistic regression and ROC analyses were used to determine the predictive value of LDH and AMY.

Results: LDH and AMY levels increased significantly with disease severity (P<0.05). Both biomarkers were independent predictors of SAP (LDH OR=1.644; AMY OR=1.670) and poor prognosis (LDH OR=1.684; AMY OR=1.730). Combined LDH+AMY demonstrated superior predictive accuracy for SAP (AUC=0.854) and short-term poor prognosis (AUC=0.884), outperforming individual markers.

Conclusions: Serum LDH and AMY are clinically valuable biochemical indicators for early identification of SAP and prediction of short-term outcomes. Their combined use significantly enhances diagnostic accuracy, supporting their integration into early biochemical risk assessment models.

References

1. Hong W, Zheng L, Lu Y, Qiu M, Yan Y, Basharat Z, et al. Non-linear correlation between amylase day 2 to day 1 ratio and incidence of severe acute pancreatitis. Front Cell Infect Mi 2022; 12(910760.
2. Shuanglian Y, Huiling Z, Xunting L, Yifang D, Yufen L, Shanshan X, et al. Establishment and validation of early prediction model for hypertriglyceridemic severe acute pancreatitis. Lipids Health Dis 2023; 22(1): 218.
3. Zhou W, Liu Q, Wang Z, Yao L, Chen J, Yang X. Analysis of the clinical profile and treatment efficiency of hyperlipidemic acute pancreatitis. Lipids Health Dis 2024; 23(1): 70.
4. Chen S, Song X, Lu J, Liang J, Ouyang H, Zheng W, et al. Application of alkaline phosphatase-to-hemoglobin and lactate dehydrogenase-to-hemoglobin ratios as novel noninvasive indices for predicting severe acute pancreatitis in patients. Plos One 2024; 19(11): e0312181.
5. Bush N, Rana SS. Ascites in Acute Pancreatitis: Clinical Implications and Management. Digest Dis Sci 2022; 67(6): 1987-93.
6. Barbieri JS, Riggio JM, Jaffe R. Amylase testing for abdominal pain and suspected acute pancreatitis. J Hosp Med 2016; 11(5): 366-8.
7. Ismail OZ, Bhayana V. Lipase or amylase for the diagnosis of acute pancreatitis? Clin Biochem 2017; 50(18): 1275-80.
8. Yang D, Lu H, Liu Y, Li M, Hu W, Zhou Z. Development and validation of a prediction model for moderately severe and severe acute pancreatitis in pregnancy. World J Gastroentero 2022; 28(15): 1588-600.
9. Rao J, Li J, Wu Y, Lai T, Zhou Z, Gong Y, et al. Ascites characteristics in acute pancreatitis: A prognostic indicator of organ failure and mortality. World J Gastroentero 2025; 31(28): 108926.
10. Lahiri D, Nag M, Banerjee R, Mukherjee D, Garai S, Sarkar T, et al. Amylases: Biofilm Inducer or Biofilm Inhibitor? Front Cell Infect Mi 2021; 11: 660048.
11. Wang Z, Liu Y, Zhang X, Wang C, Tian J, Zhao H, et al. Construction of a nomogram for hypertriglyceridemic severe acute pancreatitis that includes metabolic indexes. Lipids Health Dis 2025; 24(1): 279.
12. Tian F, Li H, Wang L, Li B, Aibibula M, Zhao H, et al. The diagnostic value of serum C-reactive protein, procalcitonin, interleukin-6 and lactate dehydrogenase in patients with severe acute pancreatitis. Clinica Chimica Acta; International Journal of Clinical Chemistry 2020; 510: 665-70.
13. Lu G, Pan Y, Kayoumu A, Zhang L, Yin T, Tong Z, et al. Indomethacin inhabits the NLRP3 inflammasome pathway and protects severe acute pancreatitis in mice. Biochem Bioph Res Co 2017; 493(1): 827-32.
14. Furey C, Buxbaum J, Chambliss AB. A review of biomarker utilization in the diagnosis and management of acute pancreatitis reveals amylase ordering is favored in patients requiring laparoscopic cholecystectomy. Clin Biochem 2020; 77: 54-6.
15. Morton A. Review article: Diagnosing acute pancreatitis in diabetes mellitus. Emergency Medicine Australasia : EMA 2022; 34(1): 6-8.
16. Wang X, Zhang Y. Diagnostic Value of Serum Amylase and Coagulation Function Indices in Distinguishing Acute Pancreatitis from Aortic Dissection. Clin Lab 2024; 70(9): 10-7754.
17. Boggio V, Gonzalez CD, Zotta E, Ropolo A, Vaccaro MI. VMP1 Constitutive Expression in Mice Dampens Pancreatic and Systemic Histopathological Damage in an Experimental Model of Severe Acute Pancreatitis. International Journal of Molecular Sciences 2025; 26(7): 3196.
18. Wang B, Huang D, Cao C, Gong Y. Insect α-Amylases and Their Application in Pest Management. Molecules 2023; 28(23): 7888.
19. Azzopardi E, Lloyd C, Teixeira SR, Conlan RS, Whitaker IS. Clinical applications of amylase: Novel perspectives. Surgery 2016; 160(1): 26-37.
20. Kumar V, Barkoudah E, Souza DAT, Jin DX, McNabb-Baltar J. Clinical course and outcome among patients with acute pancreatitis and COVID-19. Eur J Gastroen Hepat 2021; 33(5): 695-700.
21. Bengi G, Çelik İ, Dolu S, Önem S, Soytürk M, Rendeci S, et al. Neutrophil-Lymphocyte Ratio and LDH/Albumin Ratio as Biomarkers for Severity and Mortality in Acute Pancreatitis. The Turkish Journal of Gastroenterology: The Official Journal of Turkish Society of Gastroenterology 2025; 36(8): 497-507.
Published
2026/01/30
Issue
Ahead of print
Section
Original paper

Copyright (c) 2026 Jie Zheng, Jin Wang, Yinong Zhou, Tingting Yu

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The published articles will be distributed under the Creative Commons Attribution 4.0 International License (CC BY). It is allowed to copy and redistribute the material in any medium or format, and remix, transform, and build upon it for any purpose, even commercially, as long as appropriate credit is given to the original author(s), a link to the license is provided and it is indicated if changes were made. Users are required to provide full bibliographic description of the original publication (authors, article title, journal title, volume, issue, pages), as well as its DOI code. In electronic publishing, users are also required to link the content with both the original article published in Journal of Medical Biochemistry and the licence used.

Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.