Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis.
BACKGROUND
Methods for evaluation of pancreatic exocrine insufficiency (PEI) are expensive, labor intensive, and not available at many institutions. The aim of this study was to investigate if PEI in chronic pancreatitis (CP) can by predicted by nutritional markers in blood.


METHODS
A retrospective analysis of a prospectively collected database of CP patients was performed. Diagnosis of CP was based on endoscopic ultrasonography or magnetic resonance imaging. PEI was investigated by the (13)C-mixed triglyceride breath test. Hemoglobin, mean corpuscular volume, lymphocytes, prothrombin time, and serum levels of total protein, albumin, prealbumin, retinol binding protein, cholesterol, triglycerides, amylase, folic acid, vitamin B12, HbA1C, transferrin, ferritin, magnesium and zinc were analyzed.


RESULTS
114 patients were included in the study (97 males, mean age 48.1 years, 54 with alcohol etiology), 38 (33%) suffered from PEI. Magnesium below 2.05 mg/dL, hemoglobin, albumin, prealbumin and retinol binding protein below lower limit of normal and HbA1C above upper limit of normal were associated with PEI in univariate analysis. Magnesium below 2.05 mg/dL detected PEI with a sensitivity, specificity and positive and negative predictive values of 0.88 (95% confidence interval, 0.66-0.97), 0.66 (0.48-0.80), 0.58 (0.39-0.75) and 0.91 (0.73-0.98), respectively. The corresponding values were 1.00 (0.80-1.00), 0.55 (0.38-0.71), 0.52 (0.34-0.69) and 1.00 (0.82-1.00)) if one or more pathological tests among parameters significantly associated with PEI in was used as a positive test for PEI.


CONCLUSIONS
Serum nutritional markers can be used to predict the probability of PEI in CP and provide guidance in decisions on enzyme replacement therapy.
Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Björn
B
Lindkvist
J Enrique
JE
Domínguez-Muñoz
María
M
Luaces-Regueira
Margarita
M
Castiñeiras-Alvariño
Laura
L
Nieto-Garcia
Julio
J
Iglesias-Garcia
D000328:Adult; D015415:Biomarkers / Q000097:blood*; D010188:Exocrine Pancreatic Insufficiency / Q000097:blood / Q000175:diagnosis* / Q000628:therapy; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008274:Magnesium / Q000097:blood; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D019512:Pancreatitis, Alcoholic / Q000150:complications; D050500:Pancreatitis, Chronic / Q000150:complications*; D012177:Retinol-Binding Proteins / Q000032:analysis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
D015415:Biomarkers; D006442:Glycated Hemoglobin; D006454:Hemoglobins; D008274:Magnesium; D012177:Retinol-Binding Proteins; D012709:Serum Albumin