Early prediction of severe acute pancreatitis by urinary trypsinogen activation peptide.

OBJECTIVE: To investigate the value of urinary trypsinogen activation peptide (TAP) in the early prediction of severe acute pancreatitis and to compare it with acute physiology and chronic health evaluation II (APACHE II).

METHODS: We assessed the predictive value of urinary TAP concentrations measured by a competitive enzyme-linked immunosorbent assay. Urine samples were collected for detecting TAP concentrations at admission, and 24, 48, and 72 h from 41 patients with acute pancreatitis (12 with severe disease, 29 with mild disease) who presented within 48 h the onset of symptoms and from 11 control patients, while APACHE II scores were recorded at 48 h after admission.

RESULTS: The peak median urinary TAP concentration was seen at admission. The median urinary TAP concentration at admission for severe pancreatitis (95 nmol/L) was significantly higher than the median for patients with mild pancreatitis (20 nmol/L, P<0.005) and controls (15 nmol/L, P<0.005). TAP concentrations were significantly higher in patients with severe acute pancreatitis than the median in patients with mild pancreatitis (P<0.05) and controls (P<0.05) on days 2 to 3. The median APACHE II scores of severe patients were significantly different from those of mild patients (10.5 vs 6.0, P<0.01). The sensitivity, specificity, positive predictive, and negative predictive values of an admission urinary TAP>/=35 nmol/L for severe pancreatitis were 91.7%, 89.7%, 78.6% and 96.3%, whereas 48 h after admission the values for APACHE II scores (>/=9) were 75.0%, 72.7%, 52.9% and 87.5%. In prediction of disease severity, the urine TAP concentration was much better than APACHE II at 48 h.

CONCLUSIONS: Urinary TAP obtained at the first 48 h of the onset of symptoms can predict severe acute pancreatitis. In prediction of disease severity, the urinary TAP is much better than APACHE II score.