Clinical and laboratory correlates of low fecal elastase-1 levels: A retrospective analysis
International Journal of Medical Biochemistry, cilt.9, sa.4, ss.210-216, 2026 (ESCI, TRDizin)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 9 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.14744/ijmb.2026.25338
- Dergi Adı: International Journal of Medical Biochemistry
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), TR DİZİN (ULAKBİM)
- Sayfa Sayıları: ss.210-216
- İstanbul Medipol Üniversitesi Adresli: Evet
Özet
Objectives: Fecal elastase-1 (FE-1) is widely used as a noninvasive, stool-based test to evaluate pancreatic exocrine function. This study compared radiological and laboratory findings between patients with low and normal FE-1 levels and investigated variables independently associated with low FE-1 levels. Methods: The records of 1,133 patients who underwent FE-1 testing were retrospectively reviewed. Patients were classified into normal (≥200 µg/g, n=961) and low (<200 µg/g, n=172) FE-1 groups. Group comparisons and multivariable logistic regression analyses were performed. To assess the incremental discriminative contribution of pancreatic amylase while avoiding confounding due to differences in sample size, four additional models were evaluated using the same complete-case subset (n=396). Areas under the receiver operating characteristic curves (AUCs) were compared using paired DeLong tests in jamovi version 2.6.2.0. Results: Low FE-1 levels were more frequent among patients with pathological radiological findings than among those with normal findings (31.7% vs. 12.1%; χ²=45.2, p<0.001; OR=3.38, 95% CI: 2.33–4.89). Among the same 396 complete cases, Model A (age, sex, and radiology) yielded an AUC of 0.694 (95% CI: 0.619–0.769). Adding pancreatic amylase (Model B) increased the AUC to 0.727 (95% CI: 0.657–0.798), although this increase was not statistically significant (ΔAUC=0.0333; DeLong p=0.100). Model C (age, sex, radiology, ALT, glucose, BUN, IgA, and lipase) yielded an AUC of 0.740 (95% CI: 0.672–0.807). Adding pancreatic amylase (Model D) increased the AUC to 0.766 (95% CI: 0.705–0.827), but the increase was not statistically significant (ΔAUC=0.0264; DeLong p=0.107). Conclusion: Low FE-1 levels were associated with radiological, metabolic, nutritional, and laboratory abnormalities. Pancreatic amylase was independently associated with low FE-1 levels in the expanded regression model; however, its incremental contribution to AUC was not statistically significant when the models were compared using data from the same patients. These findings reflect factors associated with low FE-1 levels and should not be interpreted as establishing a diagnostic model for exocrine pancreatic insufficiency (EPI).