Role of total calcium and corrected calcium in comparisons with computed tomography to predict severity of acute pancreatitis
Keywords:Acute pancreatitis, Albumin corrected calcium, Computed tomography severity index, Sensitivity, Specificity
Background: The objective of the study was to evaluate corrected calcium levels in patient of acute pancreatitis and to evaluate role of corrected calcium as predictor of severity in acute pancreatitis in comparison to computed tomography (CT) scan.
Methods: The study was conducted in Department of Biochemistry of G.G.S Medical College in collaboration with the Department of Surgery and Department of Radio diagnosis. 50 patients, with clinical diagnosis of acute pancreatitis, attending the Inpatient Department of Department of Surgery, were taken. 50 patients, of either sex of 18 to 70 age groups suffering from acute pancreatitis were enrolled for the study.
Results: On exploring the data, highly significant negative correlation found between CT severity index (CTSI) and serum calcium (p≤0.001; r value=-0.520) whereas the non-significant correlation found between CTSI and amylase (p=0.778; r value=-0.041). The corrected calcium and CTSI shows highly negative significant correlation (p≤0.001; r value=-0.654). Serum albumin with CTSI also shows significant correlation (p=0.006; r value=0.385). But no significant association with lipase (p≥0.05).
Conclusions: We observed that corrected calcium and calcium is better and alternative marker for predicating the severity of disease because corrected calcium and calcium is having good positive predictive value to indicate progression of damage and also a highly significant negative predictive value to rule out severity of acute pancreatitis.
Norman SW, Christopher JK, Bulstrode P, Ronam O, Connell. Baileyn & Love short Practice of Surgery. Hodder Aronold 25th ed. 2008: 1138-1139.
Viljoen A, Patrick JT. In search for a better marker of acute pancreatitis: third time lucky. Clin Chem. 2011;57(11):471-3.
Chang JWT, Chung CH. Diagnosing acute pancreatitis: amylase or lipase. Hong Kong J Emerg Med. 2011;18:20-5.
Ahmed A. Hypocalcaemia in acute pancreatitis revisited. Indian J Critical Care Med. 2016;20(3):173-7.
Sava L, Pillai S, More U, Sontakke A. Serum calcium measurement total versus free (ionized) calcium Indian J Clin Biochem. 2005;20:(2):158-61.
Allam BF. Imrie CW. Serum ionized calcium in acute pancreatitis. British J Surg. 1977;64(9):665-8.
Gutiérrez-Jiménez AA. Castro W. Lagunes R. Total serum calcium and corrected calcium as severity predictors in acute pancreatitis. Revista de Gastroenterologia de Mexico. 2014;79:13-21.
Banks PA, Bollen TL, Dervenis C. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
Matull WR, Pereira SP, O’Donohue JW. Biochemical markers of acute pancreatitis. J Clin Pathol. 2006;59(4):340-44.
Shah AM, Eddi R, Kothari ST, Maksoud C, Giacomo DI, Baddoura WS, Acute pancreatitis with normal serum lipase: a case series. JOP. 2010;11(4):369-72.
Clavien PA, Robert JP. Meyer. Acute pancreatitis and normoamylasemia. Not an uncommon combination. Ann Surg. 1989;210(5):614-20.
Pezzilli R, Billi P, Miglioli. Serum amylase and lipase concentrations and lipase/amylase ratio in assessment of etiology and severity of acute pancreatitis. Dig Dis Sci. 1993;38(7):1265-9.
Lankisch PG, Burchard-Reckert S, Lehnick D. Underestimation of acute pancreatitis:patients with only a small increase in amylase/lipase levels can also have or develop severe acute pancreatitis. Gut. 1999;44:542-4.
Meher S, Mishra TS, Sasmal PK, Rath S, Sharma R, Rout B, et al. Role of Biomarkers in Diagnosis and Prognostic Evaluation Acute Pancreatitis. J Biomarkers, 2015.
Moe SM. Disorders Involving Calcium, Phosphorus, and Magnesium. Prim Care. 2008;35(2):215.
Edakkepuram U, Navas MNK, Sasi M, Parambil, Matad S. Total serum calcium and corrected calcium as severity predictors in acute pancreatitis:a prospective study in a tertiary hospital in South India, Int Surg J. 2017;4(2):560-3.
Zou C, Lu Z, Zhang Z, Zhao L, Tian L, Jiang K, Miao Y. Factors associated with pancreatic infection in patients with severe acute pancreatisis Int J Clin Exp MED. 2015;8(8):14100-4.
Gardon C. Weir. Paul B. Lesser. Lambertus J. Drop. Josef E The hypocalcaemia of acute pancreatitis ionized calcium, total calcium, PTH level. ACP. 1975;83:92.