title: Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis.
abstract: CONCLUSIONS
  Urinary TAP obtained within the first 48 h of the onset of symptoms can distinguish patients with severe acute pancreatitis.
  
  
  BACKGROUND
  Urinary trypsinogen activation peptide (TAP) has recently been described as an early marker of severity in acute pancreatitis.
  
  
  METHODS
  In a multicenter study, urine samples were collected for TAP concentration at 6-12, 24, and 48 h after admission from 139 patients with acute pancreatitis (99 with mild disease, 40 with severe disease) and from 50 control patients. Severity of acute pancreatitis was defined by the presence of organ failure and/ or pancreatic necrosis on dynamic contrast-enhanced computed tomography.
  
  
  RESULTS
  Median urinary TAP in the 139 patients with acute pancreatitis compared to the 50 control patients was significantly higher at admission, 4.6 vs 0.8 ng/mL (p < 0.001), and 6-12 h, 1.9 vs 0.55 ng/mL (p = 0.04). Among patients who presented within 48 h of the onset of symptoms, the median urinary TAP for severe pancreatitis (9 patients) compared to mild pancreatitis (40 patients) was significantly higher at admission, 29.6 vs. 3.6 ng/mL (p = 0.001). Also, when obtained within 48 h of the onset of symptoms, all patients with severe pancreatitis had an admission urinary TAP level > 10 ng/mL. The sensitivity and specificity of an admission urinary TAP > or = 10 for severe pancreatitis was 100 and 85%, respectively. Given a cutoff of 10 ng/mL for an admission urinary TAP obtained within 48 h of the onset of symptoms, the negative predictive value was 100% for mild pancreatitis.
authors.affiliation: Center for Pancreatic Disease, Brigham and Women's Hospital, Boston, MA 02115, USA.
authors.forename: S
authors.initials: S
authors.lastname: Tenner
authors.forename: C
authors.initials: C
authors.lastname: Fernandez-del Castillo
authors.forename: A
authors.initials: A
authors.lastname: Warshaw
authors.forename: W
authors.initials: W
authors.lastname: Steinberg
authors.forename: J
authors.initials: J
authors.lastname: Hermon-Taylor
authors.forename: J E
authors.initials: JE
authors.lastname: Valenzuela
authors.forename: M
authors.initials: M
authors.lastname: Hariri
authors.forename: M
authors.initials: M
authors.lastname: Hughes
authors.forename: P A
authors.initials: PA
authors.lastname: Banks
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009842:Oligopeptides / Q000652:urine*; D010195:Pancreatitis / Q000201:enzymology / Q000652:urine*; D011379:Prognosis; D014362:Trypsinogen / Q000378:metabolism
chemical_list: D015415:Biomarkers; D009842:Oligopeptides; C080396:trypsinogen activation peptide; D014362:Trypsinogen