title: The ratio of trypsin-2-alpha(1)-antitrypsin to trypsinogen-1 discriminates biliary and alcohol-induced acute pancreatitis.
abstract: BACKGROUND
  Rapid determination of the etiology of acute pancreatitis (AP) enables institution of appropriate treatment. We evaluated the ability of trypsinogen-1, trypsinogen-2, trypsin-1-alpha(1)-antitrypsin (AAT), and trypsin-2-AAT in serum to identify the etiology of AP.
  
  
  METHODS
  The study consisted of 67 consecutive patients with AP admitted to Helsinki University Central Hospital. Forty-two had alcohol-induced AP, 16 had biliary AP, and 9 had unexplained etiology. Serum samples were drawn within 12 h after admission. Trypsinogen-1, trypsinogen-2, trypsin-1-AAT, and trypsin-2-AAT were determined by time-resolved immunofluorometric assays. Logistic regression was used to estimate the ability of the serum analytes to discriminate between alcohol-induced and biliary AP. The validity of the tests was evaluated by ROC curve analysis.
  
  
  RESULTS
  Patients with alcohol-induced AP had higher median values of trypsin-1-AAT (P = 0.065), trypsinogen-2 (P = 0.034), and trypsin-2-AAT (P <0.001) than those with biliary AP, who had higher values of amylase (P = 0.002), lipase (P = 0.012), and alanine aminotransferase (P = 0.036). The ratios of trypsin-2-AAT to trypsinogen-1, lipase, or amylase efficiently discriminated between biliary and alcohol-induced AP (areas under ROC curves, 0.92-0.96).
  
  
  CONCLUSIONS
  Trypsinogen-2 and trypsin-2-AAT are markedly increased in AP of all etiologies, whereas trypsinogen-1 is increased preferentially in biliary AP. The trypsin-2-AAT/trypsinogen-1 ratio is a promising new marker for discrimination between biliary and alcohol-induced AP.
authors.affiliation: Department of Clinical Chemistry, Helsinki University Central Hospital, Haartmaninkatu 4, FIN 00290 Helsinki, Finland.
authors.forename: J M
authors.initials: JM
authors.lastname: Andersén
authors.forename: J
authors.initials: J
authors.lastname: Hedström
authors.forename: E
authors.initials: E
authors.lastname: Kemppainen
authors.forename: P
authors.initials: P
authors.lastname: Finne
authors.forename: P
authors.initials: P
authors.lastname: Puolakkainen
authors.forename: U H
authors.initials: UH
authors.lastname: Stenman
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects*; D001660:Biliary Tract Diseases / Q000150:complications*; D005260:Female; D015200:Fluoroimmunoassay; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000209:etiology*; D012372:ROC Curve; D014357:Trypsin / Q000097:blood*; D014362:Trypsinogen / Q000097:blood*; D000515:alpha 1-Antitrypsin / Q000032:analysis*
chemical_list: D007527:Isoenzymes; D000515:alpha 1-Antitrypsin; D014362:Trypsinogen; D014357:Trypsin