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

Abstract

BACKGROUNDRapid 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.AIMTo reconfirm the validity of all these markers in the diagnosis of acute pancreatitis by undertaking a multi-center study in Japan.METHODSPatients 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.RESULTSA 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.CONCLUSIONWe 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.

Multifactorial Scores and Biomarkers of Prognosis of Acute Pancreatitis: Applications to Research and Practice

“…They concluded that urinary trypsinogen-2 level >500 µg/L independently predicted local complications of AP. On the other hand, Yasuda et al [164] studied the role of urinary trypsinogen-2 and TAP to assess extra-pancreatic complications. They confirmed that the urinary trypsinogen-2 dipstick test was useful as a marker for the diagnosis of AP.…”

Diagnosis and Treatment of Acute Pancreatitis

“…Yasuda et al [ 28 ] confirmed that the rapid urinary trypsinogen-2 dipstick test and the levels of urinary trypsinogen-2 and TAP concentration may be considered as useful prognostic markers for the diagnosis of acute pancreatitis. The levels of urinary trypsinogen-2 TAP were considerably higher in patients with extended extra-pancreatic inflammation as evaluated by CT Grade, but not considerably higher in patients with hypo-enhanced pancreas lesions.…”

“…The levels of urinary trypsinogen-2 TAP were considerably higher in patients with extended extra-pancreatic inflammation as evaluated by CT Grade, but not considerably higher in patients with hypo-enhanced pancreas lesions. Therefore, the measurement of urinary trypsinogen-2 and TAP could not select the patients who should have a CT examination [ 28 ].…”

“…The diagnosis of AP by the usage of an MRI is dependent on the occurrence of morphologic and peripancreatic changes. An MRI allows a good performance of an examination detecting pancreatic necrosis and the complications of AP, such as abscesses, pseudocysts, or hemorrhage [ 28 ]. Due to the increasingly common use of new MRI techniques that provide the diagnosis of pathological conditions associated with AP, the selection of management has improved.…”

“…Despite appropriate arterial oxygenation, pleural effusion, possible intra-abdominal hypertension, or pain can lead to these symptoms. Furthermore, after fluid resuscitation, pulmonary edema may occur, which is accelerated by increased systemic permeability [ 28 , 102 ].…”