Diagnostic criteria in predicting a biliary origin of acute pancreatitis in the era of endoscopic ultrasound: multicentre prospective evaluation of 213 patients.
BACKGROUND
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).


OBJECTIVE
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.


RESULTS
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 was <48 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 (p < 0.0001), sex (p < 0.0008) and alanine transaminase (p < 0.0004) 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).


CONCLUSIONS
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.
Fédération médico-chirurgicale d'hépato-gastroentérologie, AP-HP, Hôpital Beaujon, Clichy, France. philippe.levy@bjn.ap-hop-paris.fr
Philippe
P
Lévy
Arnaud
A
Boruchowicz
Patrick
P
Hastier
Alexandre
A
Pariente
Thierry
T
Thévenot
Jean Louis
JL
Frossard
Louis
L
Buscail
François
F
Mauvais
Jean Claude
JC
Duchmann
Alain
A
Courrier
Philippe
P
Bulois
Jean Louis
JL
Gineston
Marc
M
Barthet
Henri
H
Licht
Dermot
D
O'Toole
Philippe
P
Ruszniewski
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002769:Cholelithiasis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D019160:Endosonography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D019512:Pancreatitis, Alcoholic / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D011237:Predictive Value of Tests; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012737:Sex Factors
D015415:Biomarkers; D000410:Alanine Transaminase