Total serum calcium and corrected calcium as severity predictors in acute pancreatitis

Abstract

Objectives: To evaluate total serum calcium (TC) and albumin-corrected calcium (ACC) as prognostic severity factors in acute pancreatitis (AP). Methods: Ninety-six patients were included in the study. They were diagnosed with AP and admitted to the Hospital Regional de Veracruz within the time frame of January 2010 to December 2012. AP severity was determined through the updated Atlanta Classification (2013). TC and ACC values were measured in the first 24 hours of admittance and the percentages of sensitivity (S), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR + ), and negative likelihood ratio (LR-) were calculated through ROC curves and contingency tables. Results: In accordance with the updated Atlanta Classification, 70 patients presented with mild AP, 17 with moderately severe AP, and 9 with severe AP. Of the patient total, 61.5% were women, and 69.8% presented with biliary etiology. The maximum TC cut-off point was 7.5 mg/dL, with values of S, 67%; Sp, 82%; PPV, 27%, and NPV, 96%. The maximum ACC cut-off point was 7.5 mg/dL, with values of S, 67%; Sp, 90%; PPV, 40%; NPV, 96%. Both had values similar to those of the Ranson and APACHE II prognostic scales. Conclusions: TC and ACC, measured within the first 24 hours, are useful severity predictors in acute pancreatitis, with sensitivity and predictive values comparable or superior to those of the conventional prognostic scales. Calcio sérico; Calcio corregido; Pancreatitis aguda; Severidad Calcio sérico total y calcio corregido como predictores de severidad en pancreatitis aguda ResumenObjetivo: Evaluar el calcio sérico total (CT) y el calcio corregido por albúmina (CCA) como factores pronósticos de severidad en pancreatitis aguda (PA). Métodos: Se incluyó a 96 pacientes con diagnóstico de PA ingresados de enero del 2010 a diciembre del 2012 en el Hospital Regional de Veracruz. La severidad de la PA se determinó utilizando la Clasificación de Atlanta actualizada (2013). Se recolectaron los valores de CT y CCA en las primeras 24 h a partir del ingreso y se calcularon los porcentajes de sensibilidad (S), especificidad (E), valores predictivos positivo y negativo (VPP y VPN) y razones de verosimilitud (RVP y PVN) por medio de curvas ROC y tablas de contingencia. Resultados: De acuerdo con los criterios de la Clasificación de Atlanta actualizada, 70 pacientes presentaron PA leve, 17 PA moderadamente grave y 9 PA grave. Del total de pacientes, 61.5% fueron mujeres, y el 69.8% presentó etiología biliar. El CT tuvo un punto de corte óptimo de 7.5 mg/dl, con valores de S, 67%; E, 82%; VPP, 27% y VPN, 96%. El CCA tuvo un punto de corte óptimo de 7.5 mg/dl, con valores de S 67%; E, 90%; VPP, 40%; VPN, 96%. Ambos obtuvieron valores similares a los de las escalas pronósticas de Ranson y APACHE II. Conclusiones: El CT y CCA tomados en las primeras 24 h son útiles como predictores de severidad en pancreatitis aguda, con valores de S y predictivos comparables o superiores a los de las escalas pronósticas tra...

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

“…Low serum ionized calcium (Ca 2+ ) levels have been demonstrated as playing an important role in detecting patients with severe AP [159]. Gutiérrez-Jiménez et al [160] verified a sensitivity, specificity, positive predictive value, and negative predictive value of 67%, 82%, 27%, and 96% at a maximum cut-off of 7.5 mg/dL for total calcium in predicting severe AP. Yu et al [161] showed that low serum Ca 2+ is an independent risk factor affecting the severity of AP.…”

Ideal Predictors for the Severity of Acute Pancreatitis: A single center Egyptian study

“…Although, Maher M. et.al found in a study performed on 149 patients that total calcium level has a P value of 0.67 and is statistically insignificant as a predictor of severity(7), but Gutierrez-Jimenez A. A. et al found that total calcium is a powerful predictor of severity in the first 24 hours (8). There are differences in the population numbers between the two studies and this may explain the varying results.…”

“…Body mass Index (BMI), hematocrit value, blood glucose level and pleural effusion detected by plain chest radiograph are simple tests and promising predictors to the severity of AP and provide significant data for clinical decision making and proper management (7). However, some other predictors like total serum calcium level showed mixed results (7,8).…”

Role of total calcium and corrected calcium in comparisons with computed tomography to predict severity of acute pancreatitis

“…Albumin corrected calcium (mg/dl) = total calcium (mg/dl) + 0.8 × [4-serum albumin (g/dl)]. 7 The modified CT severity index (CTSI) or Balthazar score was determined at admission and 48 hours at some time and any point of time during admission as per the need of the patient. 8 Ethical clearance was obtained from the institution review board.…”