[Simplified prognostic test in the early detection of acute pancreatitis]

Abstract

Background: Even though the diagnosis of acute pancreatitis has become easier by the measurement of specific pancreatic enzymes, early assessment of the prognosis still remains a clinical challenge at an early stage of the disease. The imaging procedures and the elevated mediators, are not widely available at the beginning. The aim of this study is to analyze the blood concentration of lipase, glucose, calcium and leucocytes (Simplified Prognostic Test). The values of these markers in the prognostic evaluation of acute pancreatitis are described.

Methods: A total of 45 patients with acute pancreatitis were evaluated; 38 patients developed a mild acute pancreatitis and 7 patients developed a severe acute pancreatitis. The values of serum markers at cut-offs of 160 mg/100 ml for glucose, 10.000 U/L for lipase, 13.000 leucocytes/100 ml and 8.5 mg/ml for calcium were monitored.

Results: On admission to hospital, concentration of glucose, lipase, calcium and leucocytes were significantly higher in the second group (severe acute pancreatitis) than in the first one (p<0.01 for glucose, leucocytes and calcium; p<0.05 for lipase). The test was considered positive if 3 out of 4 markers were significant.

Conclusions: At an early stage the SPT was positive in patients who developed severe disease. SPT had sensitivity of 71.4% and specificity of 75.5%. The preliminary results indicate that there is no significant difference between the Ranson score and SPT in evaluating acute pancreatitis. SPT is simple and quick to perform and unlike the recently introduced laboratory markers can easily be adopted in emergency clinical practice. Definite proof may however only be obtained by a prospective, randomized clinical trial.