Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis.

Abstract

OBJECTIVES: In order to define the usefulness of biochemical laboratory values in distinguishing gallstone from non-gallstone acute pancreatitis, 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 curves for each of these four parameters, we determined that the ALT level was the most clinically useful parameter. The higher the serum level of ALT, the greater its specificity and positive predictive value in diagnosing gallstone pancreatitis. At ALT levels greater than or equal to 150 IU/L (approximately a 3-fold elevation), the probability of gallstone pancreatitis is 95%. Our analyses of total bilirubin and alkaline phosphatase serum levels indicate that these tests are not useful in the diagnosis of gallstone pancreatitis. Aspartate transaminase levels are nearly as useful as ALT. CONCLUSIONS: A > or = 3-fold elevation of ALT in the presence of acute pancreatitis has a positive predictive value of 95% in diagnosing acute gallstone pancreatitis.