PREDICTING GALLSTONE PANCREATITIS WITH LABORATORY PARAMETERS - A METAANALYSIS

Objectives: In order to define the usefulness of biochemical laborator y values in distinguishing gallstone from non-gallstone acute pancreat itis, we performed a meta-analysis. Methods: Studies that utilized the bilirubin, alkaline phosphatase, alanine aminotransferase (ALT), and aspartate transaminase in the evaluation of the gallstone pancreatitis were included. Results: Using receiver operating characteristic curve s for each of these four parameters, we determined that the ALT level was the most clinically useful parameter. The higher the serum level o f ALT, the greater its specificity and positive predictive value in di agnosing gallstone pancreatitis. At ALT levels greater than or equal t o 150 IU/L (approximately a 3-fold elevation), the probability of gall stone pancreatitis is 95%. Our analyses of total bilirubin and alkalin e phosphatase serum levels indicate that these tests are not useful in the diagnosis of gallstone pancreatitis. Aspartate transaminase level s are nearly as useful as ALT. Conclusions: A greater than or equal to 3-fold elevation of ALT in the presence of acute pancreatitis has a p ositive predictive value of 95% in diagnosing acute gallstone pancreat itis.