ROSH Gastrointestinal Practice Exam

A 52-year-old man with alcohol use disorder presents with pancreatitis. Which laboratory value indicates an increased risk of mortality on admission?

1. ALT 350 mmol/L

2. LDH 400 IU/L

3. Lipase 14,000 U/L

4. WBC 15,000 cells/mm3

The correct answer is: LDH 400 IU/L

To determine the laboratory value that indicates an increased risk of mortality in a patient with pancreatitis, it's important to consider the various markers used in assessing the severity of the condition. Lactate dehydrogenase (LDH) is an enzyme that can be measured in the blood and is often elevated in cases of tissue damage, including pancreatitis. An LDH level of 400 IU/L is particularly significant in the context of pancreatitis because it indicates a higher likelihood of complications and poor outcomes. Elevated LDH levels at admission are associated with a more severe form of the disease, which correlates with an increased risk of mortality. Other laboratory values, such as ALT, lipase, and white blood cell count, can give information about the patient's condition but are not as strongly predictive of mortality. While an ALT level of 350 mmol/L and a white blood cell count of 15,000 cells/mm3 can indicate liver and inflammatory response respectively, they do not provide as clear a risk assessment as LDH does in this context. Lipase levels, although significantly elevated in this scenario, correlate with the presence of pancreatitis rather than directly indicating mortality risk. In summary, the elevated LDH level in this patient context is a strong indicator of