Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test: A prospective study

Abstract

AIM:To evaluate the use of the trypsinogen-2 dipstick (Actim Pancreatitis) test for early diagnosis and prediction of severity in acute pancreatitis (AP). METHODS:Ninety-two patients with AP were included in this study. The control group was 25 patients who had acute abdominal pain from non-pancreatic causes. Urine trypsinogen-2 dipstick test (UTDT) and conventional diagnostic tests were performed in all patients. Patients were divided by the Atlanta classification into two groups as having mild or severe pancreatitis. RESULTS:UTDT was positive in 87 (94.6%) of the AP patients and in two (8%) controls (P < 0.05). Positive UTDT was found in 61 (92.4%) of 66 (71.7%) patients with mild pancreatitis and in all (100%) of the 26 (28.3%) with severe pancreatitis (P > 0.05). UTDT positivity lasted longer in severe pancreatitis compared with that in mild pancreatitis (6.2 ± 2.5 d vs 2.0 ± 1.43 d, P < 0.05).The sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of UTDT were 91%, 72%, 96.6%, 70.4%, 3.4 and 0.1, respectively. CONCLUSION:UTDT is a simple, rapid and reliable method for use on admission. It has high specificity and low NLR for early diagnosis and prediction of severity in AP. However, its relatively low NPV does not allow trypsinogen-2 dipstick test to be a stand-alone tool for diagnosis of acute pancreatitis; the use of other conventional diagnostic tools remains a requirement.

Role of Biomarkers in Diagnosis and Prognostic Evaluation of Acute Pancreatitis

“…Both serum and urine concentrations rise within few hours of onset of disease and decline to normal level within 3 to 5 days [ 32 , 36 , 52 ]. A dipstick method using urinary trysinogen-2 has been devised for rapid detection of AP [ 32 , 53 ]. Because of its low sensitivity and less availability, this test is less frequently used in routine clinical practice [ 32 ].…”

Recent Advances in Diagnosis and Severity Assessment of Acute Pancreatitis

“…Both serum and urine concentrations of trypsinogen rise within few hours of onset of acute pancreatitis and come to normal level within 3 to 5 days (Petersson et al, 1999;Matull et al, 2006;Lippi et al, 2012). Dipstick method to detect urinary trysinogen-2 may be devised for rapid detection of AP but this method is less commonly used in routine clinical practice due to its low sensitivity, specificity and limited availability (Kamer et al, 2007;Lippi et al, 2012). Early elevated levels of urinary TAP are associated with severe acute pancreatitis (Toouli et al, 2002).…”

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

“…Trypsinogen-2 is a pancreatic enzyme known to remain elevated longer in patients with acute pancreatitis, with higher levels in the urine than in serum, compared to the commonly measured pancreatic enzyme amylase[2]. A rapid test strip for the detection of urinary trypsinogen-2 was developed in Finland and was reported to be useful for the diagnosis of acute pancreatitis[3-8], and its accuracy and usefulness was also verified in Japan[9].…”