Neopterin plasma concentrations predict the course of severe acute pancreatitis.
Kaufmann P. Tilz GP. Demel U. Wachter H. Kreijs GJ. Fuchs D.
Klinik fur Innere Medizin, Karl Franzens Universitat Graz, Austria.
In a prospective, descriptive study in 25 patients with acute pancreatitis neopterin plasma concentrations were found to be associated with the severity of the disease, which was assessed using weights of the worst 17 physiological abnormalities of the APACHE-III score over a 24 h-period after hospital admission. Neopterin concentrations were higher in severe pancreatitis (n = 10) compared to mild disease, and there existed a positive exponential correlation between neopterin and the Acute Physiology Score (r = 0.66). Higher neopterin concentrations were associated with the development of multiple organ failure (p = 0.012) and death (p = 0.019). At a cut-off concentration of 12 nmol/l the sensitivity (80%) and specificity (100%) of neopterin for the discrimination between mild and severe clinical course of pancreatitis was more accurate than C-reactive protein at a risk threshold of 1.2 g/l (70% and 87%). Development of pancreatic necrosis was associated with higher neopterin concentrations than edematous pancreatitis (p < 0.001).
Assessment of serum total and bone alkaline phosphatase measurement in clinical practice.
Romagnoli E. Minisola G. Carnevale V. Scillitani A. Frusciante V. Aliberti G. Minisola S.
Ospedale San Giovanni Battista (SMOM), Roma, Italy.
The aim of the study was to measure serum levels of the bone-specific isoenzyme of alkaline phosphatase in normal subjects and patients with metabolic bone disease by using an immunoadsorption assay. We studied 140 healthy adults, 122 patients affected by metabolic bone disease and 15 patients with cholestatic liver disease. Mean values of the bone-specific isoenzyme of alkaline phosphatase in healthy men were significantly higher than those found in premenopausal women (17.8 +/- 4.2 U/l vs 15.6 +/- 4.6 U/l, p < 0.02); postmenopausal women had significantly higher levels of bone-specific isoenzyme of alkaline phosphatase (22.6 +/- 6.4 U/l) than premenopausal women (p < 0.0001). After the menopause total alkaline phosphatase increased by 46%, while the increase in bone-specific isoenzyme of alkaline phosphatase was 39%. No significant correlations were found between bone-specific isoenzyme of alkaline phosphatase and either age or years since menopause, in postmenopausal subjects. In patients with bone-specific isoenzyme of alkaline phosphatase above the upper limit of normal, the assay had a sensitivity of 100% only in patients with Paget's disease of bone. In patients with cholestatic liver disease we found no correlation between bone-specific isoenzyme of alkaline phosphatase and either total alkaline phosphatase and gamma-glutamyl transpeptidase, while a positive correlation was found between total alkaline phosphatase and gamma-glutamyl transpeptidase. Our results confirm the role of bone-specific isoenzyme of alkaline phosphatase assay in clinical research; however, its usefulness in clinical practice is unclear once liver involvement has been excluded.
Serum CA 242: the search for a valid marker of pancreatic cancer.
Ventrucci M. Ubalducci GM. Cipolla A. Panella MA. Ligabue A.
Dipartimento di Medicina Interna e Gastroenterologia, Universita di Bologna, Italy. Ventrucc@med.unibo.it
Many efforts have been made to find valuable serum tumour markers which help the diagnosis of pancreatic cancer. In the present study we investigated the diagnostic value of CA 242 in comparison with two other routinely used tumour markers (CA 19-9 and CA 50). Two-hundred and seventy six subjects were enrolled in this study: 46 patients with pancreatic cancer preoperatively, 53 with chronic pancreatitis, 28 with acute pancreatitis, 49 with other malignancies, 50 with miscellaneous non-neoplastic digestive diseases, and 50 healthy subjects. CA 242 was determined in serum by means of a two-step fluoroimmunometric assay. Sensitivities of CA 242, CA 19-9 and CA 50 for pancreatic cancer when all patients were considered were 41.3%, 54.3% and 47.8%, respectively (95% specificity level). No significant improvement was achieved by combination of CA 242 with CA 19-9 and/or CA 50. Cholestasis affected serum levels of CA 242 in patients without pancreatic cancer, but not in those with this tumour. The metastatic stage of pancreatic cancer appeared to influence the levels of CA 242. In conclusion, CA 242 serum assay does not seem to improve diagnostic accuracy for pancreatic cancer compared to CA 19-9 and CA 50.