title: Urinary trypsin inhibitory activity for the diagnosis of bacterial infection: a prospective study in 690 patients.
abstract: OBJECTIVE
  During the acute phase response, interleukin-1 induces production of inter-alpha-trypsin inhibitor. The measurement of urinary trypsin inhibitory activity which results from the effects of inter-alpha-trypsin inhibitor degradation products is easy, quick and inexpensive. We conducted a prospective study to investigate its value as a diagnostic tool in comparison with C-reactive protein.
  
  
  METHODS
  Comparisons were made in 690 consecutive patients at admission to a department of internal medicine.
  
  
  RESULTS
  The level of urinary trypsin inhibitory activity was significantly higher in patients with bacterial infection (mean = 123 IU/g creatinine) than in patients with either viral infection (34 IU), cancer (50 IU), elevated erythrocyte sedimentation rate without infection (45 IU), miscellaneous non-inflammatory diseases (27 IU) or in non-organic controls (19 IU) (Dunnet's test, p << 0.01). The receiver operating characteristic curve showed that sensitivity and specificity of urinary trypsin inhibitory activity were higher than those of C-Reactive protein for the diagnosis of bacterial infection. For levels > or = 60 IU, sensitivity was 75% and specificity 89%. Urinary trypsin inhibitory activity levels fell within 2 days in patients treated for acute bacterial infection.
  
  
  CONCLUSIONS
  Urinary trypsin inhibitory activity could be a useful marker of bacterial infection particularly in patients with fever of unknown origin and/or elevated erythrocyte sedimentation rate.
authors.affiliation: Service de Médecine Interne, Centre médico-chirurgical Foch, Suresnes, France.
authors.forename: A M
authors.initials: AM
authors.lastname: Piette
authors.forename: J
authors.initials: J
authors.lastname: Saba
authors.forename: N
authors.initials: N
authors.lastname: Bernard
authors.forename: M
authors.initials: M
authors.lastname: Pougheon
authors.forename: O
authors.initials: O
authors.lastname: Abat
authors.forename: J
authors.initials: J
authors.lastname: Fermanian
authors.forename: J C
authors.initials: JC
authors.lastname: Piette
authors.forename: A
authors.initials: A
authors.lastname: Chapman
mesh_terms: D000510:Alpha-Globulins / Q000652:urine*; D001424:Bacterial Infections / Q000175:diagnosis*; D015415:Biomarkers / Q000652:urine*; D002097:C-Reactive Protein / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014361:Trypsin Inhibitors / Q000652:urine*
chemical_list: D000510:Alpha-Globulins; D015415:Biomarkers; D014361:Trypsin Inhibitors; C011877:inter-alpha-inhibitor; D002097:C-Reactive Protein