Trypsinogen-activation peptides in experimental rat pancreatitis: prognostic implications and histopathologic correlates.
Intrapancreatic activation of trypsinogens is believed to occur either as a cause or a consequence of acute pancreatitis and to be associated with the more severe forms of the disease. Trypsinogen-activation peptides (TAPs) were measured in plasma, urine, and ascites of rats (n = 54) assigned to different pancreatitis-inducing regimens reproducing the entire spectrum of severity. Compared with survivors, nonsurvivors at 9 hours had significantly higher TAP levels in plasma at 3 hours (P = 0.0001), urine (peak, 1-4 hours) (P = 0.004), and ascites (P = 0.0001) after death. Stepwise discriminant analysis showed that TAP in urine and plasma were the most accurate predictors of outcome (88.2% of animals) compared with other routine laboratory parameters. Morphometric analysis showed that the best histopathologic correlates of TAP elevation were acinar necrosis and intrapancreatic hemorrhage. In a second series of experiments using a homogeneous technique of induction producing pancreatitis with a mortality of 55% at 48 hours, plasma TAP level at 3 hours (cutoff, 0.5 nmol/L) and/or urinary TAP level (peak, 1-6 hours; cutoff, 25 nmol/L) accurately predicted outcome in 85% of animals. It is concluded that the TAP assay gives an accurate early prediction of outcome in different pancreatitis models and correlates best with acinar necrosis and hemorrhage.
Schmidt
J
J
Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston.
Fernández-del Castillo
C
C
Rattner
D W
DW
Lewandrowski
K
K
Compton
C C
CC
Warshaw
A L
AL
D000208:Acute Disease; D000818:Animals; D001201:Ascites / Q000097:blood / Q000652:urine; D006002:Glycodeoxycholic Acid / Q000494:pharmacology; D008297:Male; D010195:Pancreatitis / Q000139:chemically induced / Q000378:metabolism* / Q000473:pathology; D010455:Peptides / Q000378:metabolism*; D011379:Prognosis; D051381:Rats; D011919:Rats, Inbred Strains; D012720:Severity of Illness Index; D014362:Trypsinogen / Q000378:metabolism*
D010455:Peptides; D006002:Glycodeoxycholic Acid; D014362:Trypsinogen