A scoring system for early differentiation of the etiology of acute pancreatitis.

ABSTRACT

BACKGROUND: The purpose of this study was to find a new scoring system for early differentiation between the two commonest etiologies of acute pancreatitis (biliary and alcoholic), because biliary pancreatitis can be treated early by endoscopic sphincterotomy, whereas such treatment is unnecessary in alcoholics. METHODS: One hundred and forty-five patients satisfied the requirements for participation in the study and were divided into groups A (alcoholic pancreatitis) and B (biliary pancreatitis). Seven variables (serum and urine amylase, aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT), alkaline phosphatase (ALP), lipase/amylase (L/A) ratio, and erythrocyte mean corpuscular volume (MCV)) that differed in a statistically significant manner between patients of the two groups were included in the scoring system. Each parameter was counted as 0 or 1 on the basis of its values, so the patients reached scores from 0 to 7. RESULTS: Scores > or =4 (P < 0.0001) were consistently present in biliary pancreatitis, whereas alcoholics scored <4, with a sensitivity of 92.04% and a specificity of 93.75%. CONCLUSIONS: Our new scoring system could be important in the early diagnosis of the etiology of acute pancreatitis in a manner that is non-invasive, easy to calculate, inexpensive, and readily available.