Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test: a prospective study.
OBJECTIVE
To evaluate the use of the trypsinogen-2 dipstick (Actim Pancreatitis) test for early diagnosis and prediction of severity in acute pancreatitis (AP).


METHODS
Ninety-two patients with AP were included in this study. The control group was 25 patients who had acute abdominal pain from non-pancreatic causes. Urine trypsinogen-2 dipstick test (UTDT) and conventional diagnostic tests were performed in all patients. Patients were divided by the Atlanta classification into two groups as having mild or severe pancreatitis.


RESULTS
UTDT was positive in 87 (94.6%) of the AP patients and in two (8%) controls (P < 0.05). Positive UTDT was found in 61 (92.4%) of 66 (71.7%) patients with mild pancreatitis and in all (100%) of the 26 (28.3%) with severe pancreatitis (P > 0.05). UTDT positivity lasted longer in severe pancreatitis compared with that in mild pancreatitis (6.2 +/- 2.5 d vs 2.0 +/- 1.43 d, P < 0.05). The sensitivity, specificity, positive predictive value, negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ratio (NLR) of UTDT were 91%, 72%, 96.6%, 70.4%, 3.4 and 0.1, respectively.


CONCLUSIONS
UTDT is a simple, rapid and reliable method for use on admission. It has high specificity and low NLR for early diagnosis and prediction of severity in AP. However, its relatively low NPV does not allow trypsinogen-2 dipstick test to be a stand-alone tool for diagnosis of acute pancreatitis; the use of other conventional diagnostic tools remains a requirement.
Kamer
Erdinc
E
Department of Surgery, Izmir Ataturk Training and Research Hospital, 1834 sk. No. 9/4 35530 Karsiyaka-Izmir, Turkey. erdinc.kamer@gmail.com
Unalp
Haluk-Recai
HR
Derici
Hayrullah
H
Tansug
Tugrul
T
Onal
Mehmet-Ali
MA
D018806:APACHE; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000681:Amylases / Q000097:blood; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008049:Lipase / Q000097:blood; D008297:Male; D008875:Middle Aged; D010195:Pancreatitis / Q000097:blood / Q000175:diagnosis* / Q000652:urine*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011933:Reagent Kits, Diagnostic; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014357:Trypsin / Q000652:urine*; D014362:Trypsinogen / Q000652:urine*
D011933:Reagent Kits, Diagnostic; C064831:PRSS2 protein, human; D014362:Trypsinogen; D008049:Lipase; D000681:Amylases; D014357:Trypsin