The Diagnostic Usefulness of Serum Total Bile Acid Concentrations in the Early Phase of Acute Pancreatitis of Varied Etiologies.

Aleksandra Maleszka,Rafał Olszanecki,Michał Pędziwiatr,Paulina Dumnicka,Mateusz Sporek,Beata Kuśnierz-Cabala,Małgorzata Mazur-Laskowska,Aleksandra Matuszyk,Marek Kuźniewski,Piotr Ceranowicz

doi:10.3390/ijms18010106

Aleksandra Maleszka, Rafał Olszanecki + Show 8 more

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https://doi.org/10.3390/ijms18010106

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Abstract

The most common causes of acute pancreatitis (AP) are biliary tract diseases with cholestasis and alcohol consumption. In 10%–15% of patients, etiology determination is difficult. Identification of the etiology allows for the implementation of adequate treatment. The aim of this study was to assess the utility of the serum concentrations of total bile acids (TBA) to diagnose AP etiology in the early phase of the disease. We included 66 patients with AP, admitted within the first 24 h from the onset of symptoms. TBA were measured in serum at 24, 48, and 72 h from the onset of AP, using an automated fifth generation assay. The bilirubin-to-TBA ratio (B/TBA) was calculated. TBA was highest on the first day of AP and decreased subsequently. In patients with biliary etiology, serum TBA was significantly higher compared to those with alcoholic and other etiologies. B/TBA was significantly higher in patients with alcoholic etiology. At admission, the cut-off values of 4.7 µmol/L for TBA and 4.22 for the B/TBA ratio allowed for a differentiation between biliary and other etiologies of AP with a diagnostic accuracy of 85 and 83%. Both TBA and B/TBA may help in the diagnosis of AP etiology in the early phase of AP.

Highlights

Acute pancreatitis (AP) is a severe disease with high mortality and uncertain prognosis
The majority of studied patients were diagnosed with acute pancreatitis (AP) of biliary etiology (Table 1)
There were no significant differences regarding AP severity between the groups with varied etiology, the percentage of patients with mild acute pancreatitis (MAP) was the highest among those whose AP was of biliary origin and the percentage of patients with severe acute pancreatitis (SAP) was the highest among patients with alcoholic etiology (Table 1)

Summary

Introduction

Acute pancreatitis (AP) is a severe disease with high mortality and uncertain prognosis. The reason for this is its diverse etiology and the unpredictable course of the disease. Autodigestion of pancreatic tissue, which is the reason for AP, is a process dependent on early activation of inert zymogens into active digestive enzymes. The etiology of AP, apart from alcohol abuse and cholelithiasis, may include a vascular component responsible for pancreatic ischemia [6]. The majority of cases of cholelithiasis are discovered during ultrasound examination of the abdomen, but detecting minor deposits in the biliary duct or peripapillary changes (e.g., tumors) is possible thanks to endoscopic ultrasound examination (EUS). Since imaging techniques have improved, enabling the detection of micro-cholelithiasis and the so-called biliary sludge (a term used in exchange with micro-cholelithiasis), the percentage of patients with undiagnosed etiology, or idiopathic AP, has decreased considerably [9,10,11]

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