title: Elevated levels of trypsinogen-2 and trypsin-2-alpha1-antitrypsin in sera of infants and children after cardiac surgery.
abstract: Acute pancreatitis is a known complication of cardiac surgery with cardiopulmonary bypass but amylase is not a reliable marker in infants. We evaluated whether the serum concentrations of trypsinogen-2 and trypsin-2-alpha1-antitrypsin (AAT) can be used to study disturbances in pancreatic function in children and infants undergoing cardiac surgery. The study comprised 21 infants < 1 year and 25 children aged 1-16 years undergoing cardiopulmonary bypass at the Children's Hospital, Helsinki University Central Hospital. Consecutive serum samples were taken before surgery, at 12 h, 1, 2 and 3 days after surgery, and before discharge from the hospital. A moderate increase in trypsinogen-2 and trypsin-2-AAT in serum was found in more than two-thirds of the patients. On day 3, there was a 4.3-fold mean increase (CI 95% 2.8-6.5) in trypsinogen-2 and a 2.4-fold mean increase (CI 95% 1.8-3.1) in trypsin-2-AAT. In 4 patients trypsinogen-2 was elevated by more than 20-fold. One patient had clinical pancreatitis, but there were no clinical signs of pancreatitis in the other three patients. The changes in trypsinogen-2 and trypsin-2-AAT were similar in infants and children. The moderate increase in the serum concentrations of trypsinogen-2 and trypsin-2-AAT after cardiac surgery in the absence of signs of pancreatitis may be due to a subclinical pancreatic disturbance, but it could also be caused by an inflammatory response and expression of extrapancreatic trypsin. Contrary to amylase, trypsinogen-2 is expressed in the pancreas of infants.
authors: Department of Clinical Chemistry, Helsinki University Central Hospital, Finland. jan.andersen@helsinki.fi
authors: M J
authors: MJ
authors: Andersén
authors: J
authors: J
authors: Hedström
authors: T
authors: T
authors: Tikanoja
authors: M
authors: M
authors: Leijala
authors: P
authors: P
authors: Rautiainen
authors: U H
authors: UH
authors: Stenman
mesh_terms: D000208:Acute Disease; D000681:Amylases / Q000097:blood; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D002315:Cardiopulmonary Bypass; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D010195:Pancreatitis / Q000097:blood* / Q000209:etiology; D011183:Postoperative Complications / Q000097:blood*; D014357:Trypsin; D014362:Trypsinogen / Q000097:blood*; D000515:alpha 1-Antitrypsin / Q000378:metabolism*
chemical_list: D015415:Biomarkers; D000515:alpha 1-Antitrypsin; C425339:trypsin-2-alpha1-antitrypsin; C064831:PRSS2 protein, human; D014362:Trypsinogen; D002097:C-Reactive Protein; D000681:Amylases; D014357:Trypsin