Impact of renal dysfunction on the diagnosis of acute pancreatitis using urinary trypsinogen-2: A retrospective study.

AIM: Early diagnosis of acute pancreatitis is crucial, and urinary trypsinogen has been recently reported as a useful biomarker for diagnosing acute pancreatitis. We aimed to evaluate the impact of renal dysfunction on the diagnostic performance of urinary trypsinogen-2 for acute pancreatitis. METHODS: We conducted a retrospective study using the clinical data of patients who visited the Department of Emergency and Critical Care at the University of Tokyo Hospital between 1 October, 2021, and 30 June, 2022. Patients with available data on qualitative urinary trypsinogen-2 levels were identified. We compared the urinary trypsinogen-2 levels among patients who were clinically diagnosed with acute pancreatitis. We further stratified the patients according to renal function parameters, such as serum creatinine level, blood urea nitrogen level, and estimated glomerular filtration rate, and evaluated the performance of urinary trypsinogen-2 as a biomarker for acute pancreatitis. RESULTS: Within 9 months, 35 patients were identified. Of them, 22 patients showed positive results and 13 showed negative results on the urinary trypsinogen-2 test. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.80, 0.40, 0.18, and 0.92, respectively. Based on the blood urea nitrogen level and estimated glomerular filtration rate, the prevalence of false-positive results was significantly higher in patients with reduced renal function than in those with normal renal function. CONCLUSION: In patients with reduced renal function, the urinary trypsinogen-2 qualitative test results might be interpreted with caution when used for diagnosing acute pancreatitis.

Utility of point-of-care urine trypsinogen dipstick test for diagnosing acute pancreatitis in an emergency unit.

Background: A point-of-care diagnostic test for acute pancreatitis could help in early triage and management of this condition. Materials & methods: Urine trypsinogen dipstick test (UTDT) was performed in consecutive cases suspected to have acute pancreatitis and diagnostic accuracy calculated. Results: Of 187 patients, 90 were have acute pancreatitis and UTDT was positive in 61 (67.7%). In the 97 non pancreatitis cases, UTDT was positive in nine (9.3%). The sensitivity and specificity of UTDT for acute pancreatitis was 67.8% and 90.7%, respectively. In patients presenting within 3 days of abdominal pain, sensitivity and specificity were 72.7% and 91.8%, respectively. Discussion: While offering the possibility of a point of care diagnosis, the low sensitivity of UTDT could be a concern with its routine use.

Urinary trypsinogen-2 level and local complications of acute pancreatitis.

BACKGROUND AND AIM: Local complications of acute pancreatitis (AP) carry risks of morbidity/mortality. This study aimed to assess whether urinary trypsinogen-2 levels and Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission predicted subsequent local complications. METHODS: One hundred and forty-four consecutive patients with AP were prospectively followed till 6 months after discharge. Urinary trypsinogen-2 levels were measured within 24 h of admission. Local complications (acute peripancreatic fluid collection, acute necrotic collection, pseudocyst, and walled-off necrosis) were diagnosed by abdominal computed tomography. Cut-off for trypsinogen-2 level was assessed using receiver operating characteristic curve, and predictors of local complications were analyzed by logistic regression. RESULTS: Thirty-seven (25.7%) patients developed local complications. Urinary trypsinogen-2 levels were significantly higher in patients with local complications compared with those without local complications (median [interquartile range], 3210 [620-9764.4] µg/L vs 627.3 [72.3-5895] µg/L, P = 0.006). Urinary trypsinogen-2 significantly outperformed BISAP score in predicting local complications (area under the receiver operating characteristic curve 0.65 [95% CI: 0.55-0.75] vs 0.48 [95% CI: 0.38-0.58], P = 0.005). At the optimal cut-off of 500 µg/L, the sensitivity, specificity, positive predictive value, and negative predictive value of trypsinogen-2 level were 78.4%, 45.8%, 33.3%, and 86.0%, respectively. Urinary trypsinogen-2 level > 500 µg/L was an independent predictor of local complications (adjusted odds ratio, 3.72; 95% CI: 1.42-9.76; P = 0.007). By contrast, BISAP score ≥ 3 and pleural effusion predicted organ failure but not local complications. CONCLUSION: In a prospective cohort, urinary trypsinogen-2 level > 500 µg/L independently predicted local complications of AP.

Usefulness of urinary trypsinogen-2 and trypsinogen activation peptide in acute pancreatitis: A multicenter study in Japan.

BACKGROUND: Rapid urinary trypsinogen-2 dipstick test and levels of urinary trypsinogen-2 and trypsinogen activation peptide (TAP) concentration have been reported as prognostic markers for the diagnosis of acute pancreatitis. AIM: To reconfirm the validity of all these markers in the diagnosis of acute pancreatitis by undertaking a multi-center study in Japan. METHODS: Patients with acute abdominal pain were recruited from 17 medical institutions in Japan from April 2009 to December 2012. Urinary and serum samples were collected twice, at enrollment and on the following day for measuring target markers. The diagnosis and severity assessment of acute pancreatitis were assessed based on prognostic factors and computed tomography (CT) Grade of the Japanese Ministry of Health, Labour, and Welfare criteria. RESULTS: A total of 94 patients were enrolled during the study period. The trypsinogen-2 dipstick test was positive in 57 of 78 patients with acute pancreatitis (sensitivity, 73.1%) and in 6 of 16 patients with abdominal pain but without any evidence of acute pancreatitis (specificity, 62.5%). The area under the curve (AUC) score of urinary trypsinogen-2 according to prognostic factors was 0.704, which was highest in all parameter. The AUC scores of urinary trypsinogen-2 and TAP according to CT Grade were 0.701 and 0.692, respectively, which shows higher than other pancreatic enzymes. The levels of urinary trypsinogen-2 and TAP were significantly higher in patients with extended extra-pancreatic inflammation as evaluated by CT Grade. CONCLUSION: We reconfirmed urinary trypsinogen-2 dipstick test is useful as a marker for the diagnosis of acute pancreatitis. Urinary trypsinogen-2 and TAP may be considered as useful markers to determine extra-pancreatic inflammation in acute pancreatitis.

Acinar cell density at the pancreatic resection margin is associated with post-pancreatectomy pancreatitis and the development of postoperative pancreatic fistula.

BACKGROUND: There has been recent evidence supporting post-pancreatectomy pancreatitis as a factor in the development of postoperative pancreatic fistula (POPF). The aims of this study were to evaluate: (i) the correlation of the acinar cell density at the pancreatic resection margin with the intra-operative amylase concentration (IOAC) of peri-pancreatic fluid, postoperative pancreatitis, and POPF; and (ii) the association between postoperative pancreatitis on the first postoperative day and POPF. METHODS: Consecutive patients who underwent pancreatic resection between June 2016 and July 2017 were included for analysis. Fluid for IOAC was collected, and amylase concentration was determined in drain fluid on postoperative days 1, 3, and 5. Serum amylase and lipase and urinary trypsinogen-2 concentrations were determined on the first postoperative day. Histology slides of the pancreatic resection margin were scored for acinar cell density. RESULTS: Sixty-one patients were included in the analysis. Acinar cell density significantly correlated with IOAC (r = 0.566, p < 0.001), and was significantly associated with postoperative pancreatitis (p < 0.001), and POPF (p = 0.003). Postoperative pancreatitis was significantly associated with the development of POPF (OR 17.81, 95%CI 2.17-145.9, p = 0.001). DISCUSSION: The development of POPF may involve a complex interaction between acinar cell density, immediate leakage of pancreatic fluid, and postoperative pancreatitis.

Serum amylase and lipase and urinary trypsinogen and amylase for diagnosis of acute pancreatitis.

BACKGROUND: The treatment of people with acute abdominal pain differs if they have acute pancreatitis. It is important to know the diagnostic accuracy of serum amylase, serum lipase, urinary trypsinogen-2, and urinary amylase for the diagnosis of acute pancreatitis, so that an informed decision can be made as to whether the person with abdominal pain has acute pancreatitis. There is currently no Cochrane review of the diagnostic test accuracy of serum amylase, serum lipase, urinary trypsinogen-2, and urinary amylase for the diagnosis of acute pancreatitis. OBJECTIVES: To compare the diagnostic accuracy of serum amylase, serum lipase, urinary trypsinogen-2, and urinary amylase, either alone or in combination, in the diagnosis of acute pancreatitis in people with acute onset of a persistent, severe epigastric pain or diffuse abdominal pain. SEARCH METHODS: We searched MEDLINE, Embase, Science Citation Index Expanded, National Institute for Health Research (NIHR HTA and DARE), and other databases until March 2017. We searched the references of the included studies to identify additional studies. We did not restrict studies based on language or publication status, or whether data were collected prospectively or retrospectively. We also performed a 'related search' and 'citing reference' search in MEDLINE and Embase. SELECTION CRITERIA: We included all studies that evaluated the diagnostic test accuracy of serum amylase, serum lipase, urinary trypsinogen-2, and urinary amylase for the diagnosis of acute pancreatitis. We excluded case-control studies because these studies are prone to bias. We accepted any of the following reference standards: biopsy, consensus conference definition, radiological features of acute pancreatitis, diagnosis of acute pancreatitis during laparotomy or autopsy, and organ failure. At least two review authors independently searched and screened the references located by the search to identify relevant studies. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included studies. The thresholds used for the diagnosis of acute pancreatitis varied in the trials, resulting in sparse data for each index test. Because of sparse data, we used -2 log likelihood values to determine which model to use for meta-analysis. We calculated and reported the sensitivity, specificity, post-test probability of a positive and negative index test along with 95% confidence interval (CI) for each cutoff, but have reported only the results of the recommended cutoff of three times normal for serum amylase and serum lipase, and the manufacturer-recommended cutoff of 50 mg/mL for urinary trypsinogen-2 in the abstract. MAIN RESULTS: Ten studies including 5056 participants met the inclusion criteria for this review and assessed the diagnostic accuracy of the index tests in people presenting to the emergency department with acute abdominal pain. The risk of bias was unclear or high for all of the included studies. The study that contributed approximately two-thirds of the participants included in this review was excluded from the results of the analysis presented below due to major concerns about the participants included in the study. We have presented only the results where at least two studies were included in the analysis.Serum amylase, serum lipase, and urinary trypsinogen-2 at the standard threshold levels of more than three times normal for serum amylase and serum lipase, and a threshold of 50 ng/mL for urinary trypsinogen-2 appear to have similar sensitivities (0.72 (95% CI 0.59 to 0.82); 0.79 (95% CI 0.54 to 0.92); and 0.72 (95% CI 0.56 to 0.84), respectively) and specificities (0.93 (95% CI 0.66 to 0.99); 0.89 (95% CI 0.46 to 0.99); and 0.90 (95% CI 0.85 to 0.93), respectively). At the median prevalence of 22.6% of acute pancreatitis in the studies, out of 100 people with positive test, serum amylase (more than three times normal), serum lipase (more than three times normal), and urinary trypsinogen (more than 50 ng/mL), 74 (95% CI 33 to 94); 68 (95% CI 21 to 94); and 67 (95% CI 57 to 76) people have acute pancreatitis, respectively; out of 100 people with negative test, serum amylase (more than three times normal), serum lipase (more than three times normal), and urinary trypsinogen (more than 50 ng/mL), 8 (95% CI 5 to 12); 7 (95% CI 3 to 15); and 8 (95% CI 5 to 13) people have acute pancreatitis, respectively. We were not able to compare these tests formally because of sparse data. AUTHORS' CONCLUSIONS: As about a quarter of people with acute pancreatitis fail to be diagnosed as having acute pancreatitis with the evaluated tests, one should have a low threshold to admit the patient and treat them for acute pancreatitis if the symptoms are suggestive of acute pancreatitis, even if these tests are normal. About 1 in 10 patients without acute pancreatitis may be wrongly diagnosed as having acute pancreatitis with these tests, therefore it is important to consider other conditions that require urgent surgical intervention, such as perforated viscus, even if these tests are abnormal.The diagnostic performance of these tests decreases even further with the progression of time, and one should have an even lower threshold to perform additional investigations if the symptoms are suggestive of acute pancreatitis.

Pancreatic Effects of Liraglutide or Sitagliptin in Overweight Patients With Type 2 Diabetes: A 12-Week Randomized, Placebo-Controlled Trial.

OBJECTIVE: To assess the mechanistic effects of the glucagon-like peptide 1 (GLP-1) receptor agonist liraglutide and the dipeptidyl peptidase 4 (DPP-4) inhibitor sitagliptin on (exocrine) pancreatic physiology and morphology. RESEARCH DESIGN AND METHODS: For this randomized, double-blind, parallel-group trial, 55 patients with type 2 diabetes treated with metformin and/or sulfonylurea agents were included. Participants received liraglutide 1.8 mg (n = 19), sitagliptin 100 mg (n = 19), or matching placebos (n = 17) once daily for 12 weeks. The primary end point was change in exocrine function (intraduodenal pancreatic fluid secretion, lipase activity, fecal elastase-1, and chymotrypsin). Secondary end points included changes in plasma enzyme concentrations and pancreatic morphology (per MRI). RESULTS: No patient developed pancreatitis. Sitagliptin increased intraduodenal pancreatic fluid secretion by 16.3 mL (95% CI -0.3 to 32.9; P = 0.05), whereas liraglutide did not change exocrine pancreatic function. Neither therapy increased lipase/amylase levels after 12 weeks. However, liraglutide increased lipase levels after 6 weeks (23.5 U/L [95% CI 2.1-44.8]; P = 0.03) and sitagliptin increased amylase levels after 2 and 6 weeks (13.7 U/L [95% CI 3.4-23.9]; P = 0.03). Both drugs increased plasma trypsinogen after 12 weeks (liraglutide: 34.6 µg/mL [95% CI 15.1-54.2], P = 0.001; sitagliptin: 23.9 µg/mL [95% CI 4.9-42.9], P = 0.01). Neither changed pancreatic morphology, although liraglutide tended to increase pancreatic volume (7.7 cm3 [95% CI -1.2 to 16.6]; P = 0.09). Treatment-induced volume expansion was associated with increased amylase levels. CONCLUSIONS: A 12-week treatment with liraglutide or sitagliptin only resulted in a brief and modest increase of plasma pancreatic enzyme concentrations in patients with type 2 diabetes. Apart from a minimal sitagliptin-induced increase in intraduodenal fluid secretion, pancreatic exocrine function was unaffected. The long-term clinical consequences of these discrete changes require further study.

[Clinical and laboratory diagnosis of an acute biliary pancreatitis].

In 126 patients, suffering an acute biliary pancreatitis (ABP), clinical examination was conducted. In 65 patients (1-st group) the isolated cholecystolithiasis was noted; in 35 (2-nd group)--cholelithiasis, which did not cause obturation of common biliary duct; in 26 (3-rd group)--cholelithiasis, which caused the biliary ways obturation (including calculi, which were incorporated into the duodenal papilla magna ostium). Clinical course of an ABP have differed depending on localization of calculi of extrahepatic biliary ducts. In patients, suffering ABP, a biochemical signs of hepatocytes functional disorders were observed, impacting the need for hepatoprotector preparations inclusion into complex of perioperative conservative therapy. Determination of activity of pancreatic α-amylase in the blood serum and conduction of the ACTIM Pancreatitis test con- stitute the most sensitive and specific methods of the ABP biochemical diagnosis.

Urinary trypsinogen-2 for diagnosing acute pancreatitis: a meta-analysis.

BACKGROUND: Currently, serum amylase and lipase are the most popular laboratory markers for early diagnosis of acute pancreatitis with reasonable sensitivity and specificity. Urinary trypsinogen-2 (UT-2) has been increasingly used but its clinical value for the diagnosis of acute pancreatitis and post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis has not yet been systematically assessed. DATA SOURCES: A comprehensive search was carried out using PubMed (MEDLINE), Embase, and Web of Science for clinical trials, which studied the usefulness of UT-2 as a diagnostic marker for acute pancreatitis. Sensitivity, specificity and the diagnostic odds ratios (DORs) with 95% confidence interval (CI) were calculated for each study and were compared with serum amylase and lipase. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated. RESULTS: A total of 18 studies were included. The pooled sensitivity and specificity of UT-2 for the diagnosis of acute pancreatitis were 80% and 92%, respectively (AUC=0.96, DOR=65.63, 95% CI: 31.65-139.09). The diagnostic value of UT-2 was comparable to serum amylase but was weaker than serum lipase. The pooled sensitivity and specificity for the diagnosis of post-ERCP pancreatitis were 86% and 94%, respectively (AUC=0.92, DOR=77.68, 95% CI: 24.99-241.48). CONCLUSIONS: UT-2 as a rapid test could be potentially used for the diagnosis of post-ERCP pancreatitis and to an extent, acute pancreatitis. Further studies are warranted to confirm these results.

The risk for immediate postoperative complications after pancreaticoduodenectomy is increased by high frequency of acinar cells and decreased by prevalent fibrosis of the cut edge of pancreas.

OBJECTIVES: Soft pancreas is considered as a factor for pancreatitis after pancreaticoduodenectomy, which in turn constitutes a high risk for local complications. The aim was to analyze the proportion of different cell types in the cut edge of pancreas (CEP) in relation to postoperative pancreatitis and other complications after pancreaticoduodenectomy. METHODS: Data from postoperative follow-up was collected on 40 patients who had undergone pancreaticoduodenectomy. Positive urine trypsinogen-2, an early detector of pancreatitis, was checked on days 1 to 6 after operation. Drain amylase was measured on postoperative day 3. Anastomotic leakages, delayed gastric emptying, and other complications were registered. The areas of different cell types were calculated from the entire hematoxylin-eosin-stained section of CEP. RESULTS: High frequency of acinar cells in the CEP significantly increased positive urine trypsinogen-2 days, drain amylase values, and delayed gastric emptying. In a subgroup of patients with more than 40% acini in the CEP, there were significantly more postoperative complications. Increased fibrosis correlated with a small number of positive urine trypsinogen-2 days and postoperative complications. CONCLUSIONS: A large number of acinar cells in the CEP increases, whereas extensive fibrosis in the CEP decreases, the risk for postoperative complications after pancreaticoduodenectomy. These results emphasize the importance of acini in the development of postoperative complications.

Rapid urinary trypsinogen-2 test in the early diagnosis of acute pancreatitis: a meta-analysis.

OBJECTIVES: Urinary trypsinogen-2 has been implicated as a promising biomarker for the early diagnosis of acute pancreatitis (AP). The meta-analysis was used to establish the overall accuracy of urinary trypsinogen-2 test for diagnosing AP. METHODS: Based on comprehensive searches of the PubMed and Embase databases, we identified and abstracted outcome data from all articles evaluating the diagnostic value of urinary trypsinogen-2. A summary estimate for sensitivity, specificity, 95% confidence region and 95% prediction region was calculated using the bivariate random-effects approach. RESULTS: The meta-analysis included 13 studies (2342 patients, the proportion of severe AP from 13.21% to 30.00%). Overall, the pooled sensitivity was 82.3% (95%CI 79.3%-85.1%) and specificity was 93.5% (95%CI 92.2%-94.6%). The diagnostic odds ratios (DOR) was 85.23 (95%CI 40.14-180.99). The area under the summary ROC curve (AUC) was 0.9673. CONCLUSION: The urinary trypsinogen-2 test is a reliable and rapid method for the early diagnosis of AP.

Validity of the urinary trypsinogen-2 test in the diagnosis of acute pancreatitis.

OBJECTIVES: A simple urinary trypsinogen-2 test was evaluated for the diagnosis of acute pancreatitis. METHODS: This prospective multicenter study enrolled consecutive patients with acute abdominal pain who presented to the emergency department or who were hospitalized at 1 of 21 medical institutions in Japan. Patients were tested with urinary trypsinogen-2 dipstick test and a quantitative trypsinogen-2 assay, and these values were compared with serum amylase and lipase findings. RESULTS: A total of 412 patients were enrolled. The trypsinogen-2 dipstick test was positive in 107 of 156 patients with acute pancreatitis (sensitivity, 68.6%) and in 33 of 256 patients with nonpancreatic abdominal pain (specificity, 87.1%). The sensitivity for the diagnosis of pancreatitis caused by alcohol and gallstones by the dipstick test was 72.2% and 81.8%, respectively, which was much higher than those associated with amylase testing. There are several degrees of positivity within the urinary trypsinogen-2 dipstick test. Modification of the cutoff point such that positive (+) and most positive (++) results were interpreted as a positive result, the specificity and positive likelihood ratio increased to 92.2% and 7.63, respectively. CONCLUSIONS: This simple, rapid, easy, and noninvasive urinary trypsinogen-2 test can diagnose or rule out most cases of acute pancreatitis.

Elevation of urine trypsinogen 2 is an independent risk factor for pancreatic fistula after pancreaticoduodenectomy.

OBJECTIVES: Previous reports suggested that the urine trypsinogen 2 (U-TRP2) test might be a valuable method for the diagnosis of postoperative pancreatitis after pancreatic surgery. We hypothesize that the elevation of U-TRP2 level after pancreaticoduodenectomy (PD) could be associated with the occurrence of postoperative pancreatic fistula (POPF). METHODS: A total of 130 consecutive patients undergoing PD with duct-to-mucosa pancreaticogastrostomy were included. Urine samples for evaluation of U-TRP2 levels were collected prospectively. Risk factors for POPF were evaluated using univariate and multivariate analyses. RESULTS: Of 130 patients, 19 developed POPF; grade A in 14 (11%), grade B in 3 (2%), and grade C in 1 (1%). Univariate analysis demonstrated that a nonobstructed main pancreatic duct, a pancreatic duct less than 3 mm, soft texture of the pancreatic gland, a PD with antrectomy, PD with hepatic resection, hyperamylasemia, and elevation of U-TRP2 levels (>50 µg/L) were significantly associated with POPF (P < 0.05). By multivariate analysis, elevation of U-TRP2 levels (odds ratio = 4.544, P = 0.029) was the only independent risk factor that correlated with POPF. CONCLUSIONS: Elevation of U-TRP2 level is an independent risk factor for POPF after PD. Elevated U-TRP2 level might be the consequence of the postoperative pancreatitis, and postoperative pancreatitis may play an important role in the pathogenic mechanism of POPF after PD.

Rapid urinary trypsinogen-2 test strip in the diagnosis of pancreatitis after endoscopic retrograde cholangiopancreatography.

OBJECTIVES: The aim of this prospective study was to evaluate the diagnostic value of the rapid urinary trypsinogen-2 test strip in post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis. METHODS: A total of 150 patients were tested with the urinary trypsinogen-2 test strip and serum levels of amylase and lipase before ERCP and 3 hours after ERCP. The diagnostic value of urinary trypsinogen-2 strip test compared with that of serum amylase and lipase was analyzed. RESULTS: Post-ERCP pancreatitis was diagnosed in 13 (8.7%) of 150 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of urinary trypsinogen-2 dipstick test at 3 hours after ERCP are 84.6%, 97.1%, 73.3%, 98.5%, and 96%, respectively. At the cutoff level of 3 times the upper reference limit, the negative predictive values of amylase and lipase were comparable to that urinary trypsinogen-2 strip test; however, their positive predictive values (42.9% and 36.4%, respectively) were markedly lower than that of urinary trypsinogen-2 test (73.3%). CONCLUSIONS: The urinary trypsinogen-2 dipstick test is a useful test for early diagnosis of post-ERCP pancreatitis. A negative urinary dipstick test at 3 hours after the procedure rules out post-ERCP pancreatitis with a high probability and allows of early discharge plan.

Point-of-care urine trypsinogen-2 test for diagnosis of acute pancreatitis.

OBJECTIVES: To assess a point-of-care urine trypsinogen-2 (UT) test for the diagnosis of acute pancreatitis. METHODS: This was a prospective study of patients presenting to the emergency department with abdominal pain suggestive of acute pancreatitis. A 3-minute point-of-care UT test (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland) was compared with final diagnosis of acute pancreatitis, which was based on suggestive clinical features, serum lipase and/or amylase levels and imaging. RESULTS: Of 124 patients included in this study, 69 patients had final diagnosis of acute pancreatitis. The sensitivity and specificity of UT were, respectively, 73.9% (95% CI 61.9% to 83.8%) and 94.6% (95% CI 84.9% to 98.9%). CONCLUSIONS: The point-of-care UT test for acute pancreatitis had good sensitivity and specificity, and can be used reliably at the bedside to make a positive diagnosis.

Acute pancreatitis.

Acute pancreatitis (AP) is an important cause of morbidity and mortality worldwide and the annual incidence appears to be increasing. It presents as a mild self-limiting illness in 80% of patients. However, one-fifth of these develop a severe complicated life-threatening disease requiring intensive and prolonged therapeutic intervention. Alcohol and gallstone disease remain the commonest causes of AP but metabolic abnormalities, obesity and genetic susceptibility are thought be increasingly important aetiological factors. The prompt diagnosis of AP and stratification of disease severity is essential in directing rapid delivery of appropriate therapeutic measures. In this review, the range of diagnostic and prognostic assays, severity scoring systems and radiological investigations used in current clinical practice are described, highlighting their strengths and weaknesses. Increased understanding of the complex pathophysiology of AP has generated an array of new potential diagnostic assays and these are discussed. The multidisciplinary approach to management of severe pancreatitis is outlined, including areas of controversy and novel treatments.

The role of urine trypsinogen-2 test in the differential diagnosis of acute pancreatitis in the Emergency Department.

BACKGROUND: The aim of the study was to investigate the role and importance of the urine trypsinogen-2 dipstick test in the differential diagnosis of acute pancreatitis in the Emergency Department and to compare results with those of conventional tests. METHODS: The study was performed prospectively in the patients admitting to the Emergency Department due to upper abdominal pain. Thirty-two of the 87 patients included in the study had acute pancreatitis diagnosis. Serum amylase, lipase, C-reactive protein (CRP) and urine trypsinogen-2 using Actim pancreatitis dipstick were studied in all patients. The statistical analysis was performed using SPSS 11.5 package program. RESULTS: Urine trypsinogen-2 was found positive in 21 (65.6%) of 32 patients. The sensitivity of the test for pancreatitis was identified as 64%, specificity as 85%, positive predictive value as 72%, and negative predictive value as 81%. These values were statistically significant compared to the control group (p<0.01). CONCLUSION: Although it has lower sensitivity and specificity compared to amylase and lipase, we suggest that urine trypsinogen-2 test may be an important diagnostic tool in excluding the diagnosis of acute pancreatitis, since it provides results within 5 minutes in the Emergency Department, is cheaper, has a higher negative predictive value, and is easy to use.

A comparative study of the urinary trypsinogen-2, trypsinogen activation peptide, and the computed tomography severity index as early predictors of the severity of acute pancreatitis.

BACKGROUND/AIMS: The aim of the study was to establish the value of urinary trypsinogen-2 in predicting the severity of acute pancreatitis (AP) and to compare it with the accuracy of the urinary trypsinogen activation peptide (TAP) and the computed tomography severity index (CTSI). METHODOLOGY: The study population consisted of 187 consecutive patients with AP, of whom 38 had severe disease. The predictive values of urinary trypsinogen-2, TAP and CTSI were assessed within 24 h of the onset of symptoms. RESULTS: The mean values of predictive markers in the mild and severe pancreatitis groups were: urinary trypsinogen-2, 59/90 and 25/13 (p < 0.001); urinary TAP, 13.2 +/- 3.3nmol/l and 66.2 +/- 19.3 nmol/l (p < 0.001); and computed tomography severity index, 1.42 +/- 1.1 and 5.31 +/- 2.6 (p < 0.001). The sensitivity, specificity, positive predictive value, negative predictive value, and positive and negative likelihood ratios were calculated for the urinary trypsinogen-2 (65.7%, 66.4%, 33.3%, 88.4%, 1.9, and 0.51), for TAP (greater than 35 nmol/l: 63.2%, 65.8%, 32.0%, 87.5%, 1.9, and 0.58) and for CTSI (greater than 3: 47.4%, 95.3%, 69.2%, 87.7%, 9.0 and 0.55). To differentiate between severe and mild AP, urinary trypsinogen-2 (AUC 0.724) was slightly better than TAP (AUC 0.722), and they were both clearly better than CTSI (AUC 0.597) (p < 0.05). Urinary trypsinogen-2 had significantly lower cost (p < 0.001) than TAP and computed tomography. CONCLUSION: Urinary trypsinogen-2 was superior to CTSI and was as good as or even better than urinary TAP in the early prediction of severity in AP. This suggests that this simple and quick method deserves routine clinical application.

Urinary trypsinogen-2 dipstick in acute pancreatitis.

OBJECTIVES: In acute pancreatitis (AP), rapid diagnosis and early treatment are of importance for clinical outcome. Urinary trypsinogen-2 has been suggested as a promising diagnostic marker; however, studies using the urinary trypsinogen-2 dipstick test (UTDT) have provided varying results. METHODS: The study was set to evaluate the use of the UTDT (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland, Medinor, Roskilde, Denmark) in apparent first attack of AP in daily clinics. Acute pancreatitis was defined as more than a 3-fold increase in plasma amylase levels. We included 75 patients admitted with AP. Thirty-four patients with acute abdominal pain of causes other than AP served as a control group. RESULTS: In 58 of 75 patients, the UTDT result was positive, giving a sensitivity of 77% (95% confidence interval [CI]: 66%-86%). In severe cases, the sensitivity improved to 87% (95% CI: 69%-96%). In 33 of 34 controls, the test result was negative, giving a specificity of 97% (95% CI: 84%-99.9%). CONCLUSION: The UTDT had a low sensitivity but high specificity. These results do not support the UTDT to replace standard plasma amylase for the diagnosis of apparent first attack of AP. However, the test demonstrated an adequate sensitivity to be used for rapid early screening of AP in daily clinics.

Valor diagnóstico y pronóstico de la determinación de tripsinógeno-2 urinario en pacientes con pancreatitis aguda / Usefulness of determining urinary trypsinogen-2 in diagnosis and prognosis of patients with acute pancreatitis

Fundamento. Estudiar el papel del tripsinógeno-2 urinarioen el diagnóstico y pronóstico inicial de pacientescon pancreatitis aguda (PA) así como su relación con laestancia media hospitalaria y la mortalidad.Método. Se incluyeron 42 pacientes diagnosticados dePA a los que se realizó hematimetría, bioquímica sanguínea,amilasuria y tripsinógeno-2 urinario. Se establecióun punto de corte de 50 μg/L y una segunda dilución a2.000 μg/L. Otras variables incluidas fueron etiología, estanciamedia hospitalaria, traslado a UCI y fallecimiento.Resultados. De los 42 pacientes, 29 (69%) eran hombresy 13 (31%) mujeres; edad media 61 años. La etiologíamás frecuente era la biliar, seguida del alcohol. Estanciamedia: 8,38 días. Traslado a UCI en 4 (9,5%) pacientes.Dos de los pacientes trasladados a UCI y otro que norequirió traslado fallecieron (7,14%). La amilasa séricafue elevada en 33 (78,57%) pacientes y la lipasa en36 (85,71%). El tripsinógeno urinario fue positivo en34 pacientes (80,95%). Se evidenció asociación entretripsinógeno-2 urinario y edad (p=0,016; r=0,893), glucemia(p=0,005, r=0,901), amilasa plasmática (p=0,029;r=0,852), lipasa (p=0,022; r=0,809) e hipoxemia (p=0,001;r=0,962). En cuanto a la estancia media, se observóasociación estadística con edad (p=0,046; r=0,784) yacidosis metabólica (p=0,016; r=0,839). La mortalidadse asoció a hipocalcemia (p=0,008; r=0,899) y acidosismetabólica (p=0,032; r=0,814).Conclusión. La determinación del tripsinógeno-2 urinarioen pacientes con PA es un test útil y rápido. Lospacientes mayores de 65 años, con hipoxemia, acidosismetabólica e hipocalcemia tienen tendencia a presentaruna estancia media hospitalaria prolongada y mayormortalidad(AU)

Background. To study the role of urinary trypsinogen-2in diagnosing and early prognosis of patients with acutepancreatitis (AP) and the relationship to length of hospitalstay and mortality.Methods. Forty-two patients were included in the study.In all cases, blood cell count, serum chemistry, urineamylase and urine trypsinogen-2 were measured. Acut-off of 50 μg/L was established and, when positive, asecond dilution was made (2000 μg/L). Other variablesincluded were etiology, mean length of hospital stay,transfer to an ICU and death.Results. Out of the 42 patients, 29 (69%) were men and13 (31%) women. Average age was 61 years. The most frequentcause was biliary, followed by alcohol. Mean hospitalstay was 8.38 days. Transferred to an ICU: 4 (9.5%)patients. Two of them and a third, who had not beentransferred, died (7.14%). High serum amylase was foundin 33 (78.57%) patients and high lipase in 36 (85.71%).Urinary trypsinogen-2 was positive in 34 patients(80.95%). Statistical association between urinary trypsinogen-2 and age (p=0.016; r=0.893), glucose (p=0.005;r=0.901), serum amylase (p=0.029; r=0.852), lipase(p=0.022; r=0.809) and hypoxemia (p=0.001; r=0.962) wasfound. Regarding hospital stay, there was statistical associationwith age (p=0.046; r=0.784) and metabolic acidosis(p=0.016; r=0.839). With respect to mortality therewas statistical association with hypocalcemia (p=0.008;r=0.899) and metabolic acidosis (p=0.032; r=0.814).Conclusion. Testing urinary trypsiongen-2 in patientswith AP is rapid and useful. Patients over the age of 65with hypoxia, metabolic acidosis and hypocalcemiatend to present a prolonged average hospital stay andhigher mortality(AU)