1622-P: Congruence of Laboratory vs. Histopathologic Findings of Acute Pancreatitis within nPOD Organ Donors

Acute pancreatitis may both result in development of diabetes and is more common in patients with diabetes. Due to its broad presentation, diagnosis typically includes elevated amylase or lipase values three times normal. We aimed to evaluate the performance of amylase and lipase as predictors of acute pancreatitis by histopathology in deceased organ donors within The Network for Pancreatic Organ Donors with Diabetes (nPOD) tissue biobank.Demographic and clinical characteristics were collected from deidentified terminal hospital records. Acute pancreatitis by laboratory criteria was defined as an amylase >420 U/L or lipase >240 U/L. Pancreatic histopathologic analysis was performed to evaluate for acute pancreatitis (acinar cell loss, polymorphonuclear cell infiltrate, fat necrosis, and hemorrhage) in organ donors with and without diabetes.Acute pancreatitis by histopathology was associated with higher mean amylase (477 vs 194; p=0.007) and lipase (823 vs 134 U/L; p=0.003) and acute pancreatitis by laboratory criteria (p=0.0005). However, 38% of individuals with acute pancreatitis by histopathology did not meet laboratory criteria (sensitivity 61.8%; specificity 83%). The positive and negative predictive value of these cutoffs were 70% and 77.2% respectively. Within individuals with type 1 diabetes (T1D), a diagnosis of diabetic ketoacidosis (DKA) was associated with elevated amylase and lipase (mean of 74.5 U/L and 83 U/L without and 461 U/L and 725 U/L with DKA, p<0.03) and acute pancreatitis by laboratory criteria (p=0.006) but not by histopathology (p=0.23). However, the sensitivity and positive predictive value of acute pancreatitis laboratory criteria in donors with DKA improved (73.3% and 85%).Acute pancreatitis diagnosed by laboratory criteria alone is specific at 83% but with a lower sensitivity of 61.8%. These criteria can still be used in T1D individuals with DKA with a higher sensitivity and positive predictive value.