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Clinical usefulness of polymorphonuclear elastase in predicting the severity of acute pancreatitis: Results of a multicentre study

1991; Oxford University Press; Volume: 78; Issue: 10 Linguagem: Inglês

10.1002/bjs.1800781027

1365-2168

J. Enrique Domínguez‐Muñoz, Fernando Carballo, Julio de la Morena, María José Sánchez García, J. Miguel de Diego, Luís Rábago, Miguel Ángel Simón,

Liver Disease Diagnosis and Treatment

Abstract The usefulness and clinical applicability of quantitative plasma polymorphonuclear elastase determinations in the diagnosis of the severity of acute pancreatítis was analysed in a multicentre study and was compared with the usual prognostic systems of Ranson and Osborne et al. The study comprised 182 patients, 154 with a mild episode of acute pancreatitis and 28 with a severe episode, defined by the development of major complications or a fatal outcome. In the severe cases neutrophilic elastase reached significantly higher values than in mild cases (P < 0·001) by the time the patient was admitted (2–12 h after the onset of the disease), reflecting considerable leucocyte activation. The sensitivity and specificity of this test are therefore greater than 90 per cent, with a positive severity predictive value of almost 80 per cent at the time of admission and 97 per cent after 24 h, and a negative predictive value of approximately 98 per cent. In addition to requiring 48 h for evaluation, the usual prognostic systems show a sensitivity of 77-85 per cent, a specificity of 70–77 per cent, a positive predictive value of 40–48 per cent, and a negative predictive value of 92–95 per cent, clearly lower than those obtained with leucocyte elastase. Polymorphonuclear elastase is therefore a very early and reliable marker in the diagnosis of the severity of acute pancreatitis, in addition to being easily adaptable to the routine of any hospital laboratory.