The biochemical detection of biliary etiology of acute pancreatitis on admission: a revisit in the modern era of biliary imaging.
BACKGROUND
Compared with traditional radiologic methods for the detection of cholelithiasis, early transient hypertransaminasemia had provided a useful prediction of biliary etiology in patients with acute pancreatitis.


OBJECTIVE
To investigate whether this application remains valid in the modern era of imaging for microlithiasis.


METHODS
The biochemical detection (LFT) of cholelithiasis was based on an increase in serum alanine transaminase of >or=80 IU/L (normal range, 0-45 IU/L) within 24 hours of admission. We have taken the collective findings of abdominal ultrasound (USS), endoscopic ultrasound (EUS), and postmortem examination to represent the denominator for the diagnosis of cholelithiasis against which comparison with LFT was made.


RESULTS
Of 68 patients with acute pancreatitis who were treated between October 2000 and December 2001, cholelithiasis was the etiological factor in 44 patients (65%). EUS detected microlithiasis in 5 of 10 patients examined. The etiology remained idiopathic in 3 patients (4.4%). The sensitivity, specificity, and positive and negative predictive values for USS were 86%, 100%, 100%, and 80% respectively; for LFT, they were 91%, 100%, 100%, and 86%; and for USS and LFT combined, they were 98%, 100%, 100%, and 96%, respectively.


CONCLUSIONS
In patients with acute pancreatitis, the biochemical analysis within 24 hours of admission provided a simple, rapid, and more accurate prediction of cholelithiasis than USS. The combination of LFT and USS detected or excluded a biliary etiology in almost all patients.
Ammori
B J
BJ
Royal Gwent Hospital, Cardiff Road, Newport, Gwent, UK. Bammori@aol.com
Boreham
B
B
Lewis
P
P
Roberts
S A
SA
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood*; D001659:Biliary Tract / Q000000981:diagnostic imaging; D002769:Cholelithiasis / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D019160:Endosonography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000209:etiology*; D010343:Patient Admission; D011237:Predictive Value of Tests
D000410:Alanine Transaminase