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Overview :
Stimac et al developed a scoring system based on clinical
laboratory findings which allows the differentiation between the 2 commonest
causes of acute pancreatitis - biliary stone disease and alcoholism. The method
is simple, noninvasive and readily available.
Parameters:
(1) serum amylase in IU/L
(2) alanine aminotransferase (SGPT) in IU/L
(3) aspartate aminotransferease (SGOT) in IU/L
(4) alkaline phosphatase in IU/L
(5) lipase to amylase ratio
(6) MCV in femtoliters
(7) urine amylase in IU/L
|
Parameter |
Finding |
Score |
|
serum amylase |
> 450 IU/L |
1 |
|
|
<= 450 IU/L |
0 |
|
alanine aminotransferase |
> 70 IU/L |
1 |
|
|
<= 70 IU/L |
0 |
|
aspartate aminotransferase |
> 60 IU/L |
1 |
|
|
<= 60 IU/L |
0 |
|
alkaline phosphatase |
> 100 IU/L |
1 |
|
|
<= 100 IU/L |
0 |
|
lipase to amylase ratio |
>= 2 |
0 |
|
|
< 2 |
1 |
|
MCV |
>= 96 fl |
0 |
|
|
< 96 |
1 |
|
urine amylase |
> 3,000 IU/L |
1 |
|
|
<= 3,000 IU/L |
0 |
score =
= SUM(points for all 7 parameters)
Interpretation:
• minimum score: 0
• maximum score: 7
• A score >= 4 was seen in biliary pancreatitis.
• A score < 4 was seen in alcoholic pancreatitis.
Performance
in study population:
• The
sensitivity was 92%, specificity 94%, positive predictive value 98%, negative
predictive value 77%, and diagnostic efficiency 92%.
Limitations:
• Variation
between methods used to measure the clinical analytes can shift the cutoff
points. Use of multiples of the upper limit of normal could help, but this can
be affected by variation in the patient population.
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