Article Text

PDF
Predicting a biliary aetiology in paediatric acute pancreatitis
  1. Michael J Coffey1,
  2. Scott Nightingale2,3,
  3. Chee Y Ooi1,4
  1. 1School of Women's and Children's Health, Medicine, University of New South Wales, Sydney, New South Wales, Australia
  2. 2Department of Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
  3. 3Discipline of Paediatrics and Child Health, School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  4. 4Department of Gastroenterology, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia
  1. Correspondence to Dr Chee Y Ooi, Sydney Children's Hospital, School of Women's and Children's Health, High Street, Randwick, Sydney, NSW 2031, Australia; keith.ooi{at}unsw.edu.au

Abstract

Objective Acute biliary pancreatitis (ABP) is a common cause of pancreatitis which may require timely intervention. We aimed to identify routine laboratory parameters for early prediction of biliary aetiology in paediatric acute pancreatitis (AP).

Design A retrospective review of children with AP (January 2000–July 2011) was performed at two tertiary paediatric hospitals in New South Wales, Australia. Predictors of ABP using laboratory parameters (measured within 48 h of presentation) were determined using a multivariate logistic regression model and evaluated.

Results Of the 131 pancreatitis episodes reviewed, 21 (16%) were biliary-related. Raised serum lipase, alkaline phosphatase, γ-glutamyl transpeptidase (GGT), alanine aminotransferase (ALT) and aspartate aminotransferase were associated with biliary aetiology (all p<0.0016) on univariate analysis. In multiple logistic regression, serum GGT ≥40 U/L, ALT ≥150 U/L, and lipase ≥15×the upper limit of normal (ULN) were predictive of ABP. To improve clinical applicability, the predictive performance when at least two of the three ABP predictors (coined the ‘biliary pancreatitis triad’) were satisfied was evaluated. The triad performed with a specificity, sensitivity, positive predictive value and negative predictive value of 95, 89, 76 and 98%, respectively.

Conclusions The biliary pancreatitis triad of serum GGT ≥40 U/L, ALT ≥150 U/L and lipase ≥15×ULN within 48 h of presentation may be used as simple clinical predictors of ABP in children. Children with values falling below 2 or 3 of these thresholds are very unlikely to have AP due to a biliary cause.

  • Gastroenterology
  • General Paediatrics

Statistics from Altmetric.com

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.