Diagnostic criteria in predicting a biliary origin of acute pancreatitis in the era of endoscopic ultrasound: Multicentre prospective evaluation of 213 patients
| Autor: | Alain Courrier, Louis Buscail, François Mauvais, Henri Licht, Jean Louis Gineston, Dermot O'Toole, Jean Claude Duchmann, Patrick Hastier, Arnaud Boruchowicz, Philippe Ruszniewski, Thierry Thevenot, Marc Barthet, Philippe Bulois, Philippe Lévy, Jean-Louis Frossard, Alexandre Pariente |
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| Rok vydání: | 2005 |
| Předmět: |
Adult
Male Endoscopic ultrasound medicine.medical_specialty Adolescent Pancreatitis Alcoholic Endocrinology Diabetes and Metabolism Endoscopic ultrasonography Sensitivity and Specificity Gastroenterology Prospective evaluation Endosonography Diagnosis Differential Sex Factors Cholelithiasis Predictive Value of Tests Risk Factors Internal medicine medicine Humans Aged Aged 80 and over Hepatology medicine.diagnostic_test business.industry Alanine Transaminase Middle Aged medicine.disease Clinical trial Pancreatitis Predictive value of tests Acute Disease Acute pancreatitis Female Radiology Differential diagnosis business Biomarkers |
| Zdroj: | Pancreatology. 5:450-456 |
| ISSN: | 1424-3903 |
| DOI: | 10.1159/000086547 |
| Popis: | No study on bioclinical criteria predicting a biliary origin for acute pancreatitis has included endosonography as a reference examination. Re-examination of bioclinical parameters deserves consideration in the era where other causes are known (e.g. hereditary, autoimmune).To determine the performance of bioclinical markers in predicting a biliary origin of acute pancreatitis where the diagnosis of biliary lithiasis was established or ruled out using endosonography. Only patients with a first acute episode of pancreatitis were included.213 patients (male: 55%; median age: 56 years) were prospectively included in 14 centres. Causes of acute pancreatitis were: biliary (62%), alcoholic (25%), other (13%). Delay between symptom-onset and admission was48 h in 80%. Endosonography was the sole method establishing the diagnosis of biliary pancreatitis in 15% of patients. At univariate analysis, age, female sex, declared alcohol consumption, elevated aspartate and alanine transaminases on admission, gammaglutamyl transferase, alkaline phosphatase, total bilirubin, lipase, mean corpuscular volume were predictive of a biliary origin. Only age (p0.0001), sex (p0.0008) and alanine transaminase (p0.0004) remained significant at multivariate analysis. At age 50, the respective sensitivity and specificity were 73 and 65%. With an elevated alanine transaminase at 2 times the upper limit of normal range, the respective sensitivity and specificity were 74 and 84%. The probability of a biliary origin of acute pancreatitis could be estimated by the following formula: = 1/1 + exp(4.6967 - 0.0656 x age + 1.1208 x sex - 0.6909 x alanine transaminase).When endosonography is performed to confirm or exclude a biliary origin of acute pancreatitis, age, sex and alanine transaminase at admission are the only factors predictive of a biliary cause. |
| Databáze: | OpenAIRE |
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