Khoury Tawfik, Kadah Anas, Mahamid Mahmud, Mari Amir, Sbeit Wisam
Faculty of Medicine in the Galilee, Bar-Ilan University, Safed 1311502, Israel.
World J Clin Cases. 2020 Apr 26;8(8):1414-1423. doi: 10.12998/wjcc.v8.i8.1414.
Retained common bile duct (CBD) stone after an acute episode of biliary pancreatitis is of paramount importance since stone extraction is mandatory.
To generate a simple non-invasive score to predict the presence of CBD stone in patients with biliary pancreatitis.
We performed a retrospective study including patients with a diagnosis of biliary pancreatitis. One hundred and fifty-four patients were included. Thirty-three patients (21.5%) were diagnosed with CBD stone by endoscopic ultrasound (US).
In univariate analysis, age (OR: 1.048, = 0.0004), aspartate transaminase (OR: 1.002, = 0.0015), alkaline phosphatase (OR: 1.005, = 0.0005), gamma-glutamyl transferase (OR: 1.003, = 0.0002) and CBD width by US (OR: 1.187, = 0.0445) were associated with CBD stone. In multivariate analysis, three parameters were identified to predict CBD stone; age (OR: 1.062, = 0.0005), gamma-glutamyl transferase level (OR: 1.003, = 0.0003) and dilated CBD (OR: 3.685, = 0.027), with area under the curve of 0.8433. We developed a diagnostic score that included the three significant parameters on multivariate analysis, with assignment of weights for each variable according to the co-efficient estimate. A score that ranges from 51.28 to 73.7 has a very high specificity (90%-100%) for CBD stones, while a low score that ranges from 9.16 to 41.04 has a high sensitivity (82%-100%). By performing internal validation, the negative predictive value of the low score group was 93%.
We recommend incorporating this score as an aid for stratifying patients with acute biliary pancreatitis into low or high probability for the presence of CBD stone.
急性胆源性胰腺炎发作后胆总管结石残留至关重要，因为必须取出结石。
生成一种简单的非侵入性评分，以预测胆源性胰腺炎患者是否存在胆总管结石。
我们进行了一项回顾性研究，纳入诊断为胆源性胰腺炎的患者。共纳入154例患者。33例患者（21.5%）经内镜超声检查诊断为胆总管结石。
单因素分析中，年龄（比值比：1.048，P = 0.0004）、天冬氨酸转氨酶（比值比：1.002，P = 0.0015）、碱性磷酸酶（比值比：1.005，P = 0.0005）、γ-谷氨酰转移酶（比值比：1.003，P = 0.0002）以及超声测量的胆总管宽度（比值比：1.187，P = 0.0445）与胆总管结石相关。多因素分析中，确定了三个预测胆总管结石的参数；年龄（比值比：1.062，P = 0.0005）、γ-谷氨酰转移酶水平（比值比：1.003，P = 0.0003）和胆总管扩张（比值比：3.685，P = 0.027），曲线下面积为0.8433。我们根据多因素分析中的三个显著参数制定了一个诊断评分，并根据系数估计为每个变量赋予权重。评分在51.28至73.7之间对胆总管结石具有非常高的特异性（90%-100%），而评分在9.16至41.04之间具有高敏感性（82%-至100%）。通过内部验证，低分组合的阴性预测值为93%。
我们建议将该评分作为一种辅助手段，用于将急性胆源性胰腺炎患者分为胆总管结石存在可能性低或高的类别。
