Biochemical parameters in the early differentiation of the etiology of acute pancreatitis.

Objectives: We undertook a retrospective study to define the usefulness of various biochemical parameters in differentiation between alcoholic and nonalcoholic acute pancreatitis.

Methods: One hundred sixty-seven patients were divided into groups A (alcoholic pancreatitis) and NA (nonalcoholic pancreatitis). Group NA was further subdivided into groups B (biliary pancreatitis) and NANB (nonalcoholic, nonbiliary pancreatitis). The values of serum and urine amylase, serum lipase, AST, ALT, alkaline phosphatase, gamma glutamyl transferase, bilirubin, lipase/amylase ratio, and erythrocyte mean corpuscular volume were investigated.

Results: Serum amylase, ALT, AST, alkaline phosphatase (p < 0.001), and urine amylase (p < 0.01) were significantly lower in patients with alcoholic pancreatitis. Erythrocyte mean corpuscular volume and lipase/amylase ratio were significantly higher in patients with alcoholic pancreatitis (p < 0.001). There were no differences in lipase, bilirubin, and gamma glutamyl transferase between patients with alcoholic pancreatitis and those with nonalcoholic pancreatitis. Multivariate analysis showed that a combination of three variables (lipase/amylase ratio, erythrocyte mean corpuscular volume, and alkaline phosphatase) differentiated between alcoholic and nonalcoholic pancreatitis.

Conclusions: Various biochemical parameters used together and with other clinical features can help in the early differentiation between alcoholic and nonalcoholic acute pancreatitis.