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.
