Critérios laboratoriais para o diagnóstico diferencial entre pancreatite aguda biliar e não biliar
Data
2021
Autores
Azevedo, Barbra Rafaela de Melo Santos 
Orientadores
Fagundes, Djalma José
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Objetivos: estabelecer critérios laboratoriais para o diagnóstico diferencial entre
pancreatite aguda de causa biliar e não biliar e identificar testes com sensibilidade
suficiente para propor a criação de um algoritmo para essa finalidade. Métodos:
análise retrospectiva observacional, com delineamento transversal, de exames
laboratoriais de dois grupos de pacientes com pancreatite aguda: A – causa não biliar
e B – causa biliar. Foram investigados os exames: hematócrito, número de leucócitos,
lactato desidrogenase (LDH), glicose, lipase, amilase, bilirrubina total, transaminase
oxalacética (TGO/AST), transaminase pirúvica (TGP/ALT), gamaglutamiltransferase
(GGT) e fosfatase alcalina (FA). Os dados de 701 pacientes foram submetidos a testes
não paramétricos e ao Receiver Operating Characteristic (ROC). Resultados: os
valores de hematócrito, número de leucócitos, LDH e glicose não apresentaram
diferença significante entre os grupos (p > 0.1); já os valores de lipase, amilase,
bilirrubina total, TGO, TGP, GGT e FA apresentaram diferença significante entre os
grupos (p < 0.05), sendo que os testes de TGP, TGO e FA mostraram-se os mais
sensíveis na determinação da causa biliar, possibilitando o estabelecimento de um
ponto de corte pelo teste ROC, a partir do qual a probabilidade de acerto aumenta:
TGP: 123,0 U/L (S: 69,2%; E: 81,5%), TGO: 123,5 U/L (S: 57,3%; E: 78,8%), FA: 126,5
U/L (S: 66,1%; E: 69,4%). Conclusão: foi possível estabelecer critérios baseados em
testes laboratoriais, para o diagnóstico diferencial entre pancreatite aguda de origem
biliar e não biliar, no entanto, os testes não mostraram sensibilidade suficiente para
propor a criação de um algoritmo.
Objectives: to establish laboratory criteria for the differential diagnosis between acute pancreatitis of biliary and no-biliary causes and identify tests with sufficient sensitivity to propose the creation of an algorithm for this special one. Methods: retrospective observational analysis, with cross-sectional design, laboratory tests of two groups of patients with acute pancreatitis: A - no-biliary cause and B - biliary cause. The following tests were investigated: hematocrit, leukocyte number, lactate dehydrogenase (LDH), glucose, lipase, amylase, total bilirubin, oxaloacetic transaminase (GOT/AST), pyruvic transaminase (GPT/ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP). Data from 701 patients were discovered in nonparametric tests and the Receiver Operating Characteristic (ROC). Results: the values of hematocrit, number of leukocytes, LDH and glucose did not dissipate significant difference between groups (p > 0.1); on the other hand, the values of lipase, amylase, total bilirubin, GOT, GPT, GGT and ALP dissipated significantly between the groups (p < 0.05), with the GPT, GOT and ALP tests being the most sensitive in the determination of biliary cause, enabling the establishment of a cutoff point by the ROC test, from which a probability of correctness increases: GPT: 123.0 U/L (S: 69.2%; E: 81.5%), GOT: 123.5 U/L (S: 57.3%; E: 78.8%), ALP: 126.5 U/L (S: 66.1%; E: 69.4%). Conclusion: it was possible to establish criteria based on laboratory tests for the differential diagnosis between acute pancreatitis of biliary and no-biliary origin, however, the tests do not have sufficient sensitivity to propose the creation of an algorithm.
Objectives: to establish laboratory criteria for the differential diagnosis between acute pancreatitis of biliary and no-biliary causes and identify tests with sufficient sensitivity to propose the creation of an algorithm for this special one. Methods: retrospective observational analysis, with cross-sectional design, laboratory tests of two groups of patients with acute pancreatitis: A - no-biliary cause and B - biliary cause. The following tests were investigated: hematocrit, leukocyte number, lactate dehydrogenase (LDH), glucose, lipase, amylase, total bilirubin, oxaloacetic transaminase (GOT/AST), pyruvic transaminase (GPT/ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP). Data from 701 patients were discovered in nonparametric tests and the Receiver Operating Characteristic (ROC). Results: the values of hematocrit, number of leukocytes, LDH and glucose did not dissipate significant difference between groups (p > 0.1); on the other hand, the values of lipase, amylase, total bilirubin, GOT, GPT, GGT and ALP dissipated significantly between the groups (p < 0.05), with the GPT, GOT and ALP tests being the most sensitive in the determination of biliary cause, enabling the establishment of a cutoff point by the ROC test, from which a probability of correctness increases: GPT: 123.0 U/L (S: 69.2%; E: 81.5%), GOT: 123.5 U/L (S: 57.3%; E: 78.8%), ALP: 126.5 U/L (S: 66.1%; E: 69.4%). Conclusion: it was possible to establish criteria based on laboratory tests for the differential diagnosis between acute pancreatitis of biliary and no-biliary origin, however, the tests do not have sufficient sensitivity to propose the creation of an algorithm.