Application of an Express Urinary Trypsinogen-2 Test for the Diagnosis of Acute Pancreatitis

Early diagnosis of acute pancreatitis (AP) and special assessment of the severity of the disease are of great clinical importance. The aim of this study was to evaluate the diagnostic accuracy of a urine trypsinogen-2 dipstick test (cutoff, 50 Kg/L) (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland) in patients with AP. The test was performed on 16 patients with AP and on 29 controls without AP but with other acute surgical diseases. The severity of AP was established according to clinical, computed tomographic, and laboratory data obtained from each patient. Positive test results were recorded on 13 patients with AP between the 12th hour after admission and the 6th day of hospitalization (sensitivity, 81%) and on 15 control group patients between the 12th hour after admission and the 9th day of hospitalization, indicating a specificity of 50%. Six patients exhibited severe AP (37%). Five of these (85%) had positive test results between the 24th hour after admission and the 6th day of hospitalization. Among these 5 positive cases, there were 2 deaths. In 11 patients with AP (and in 7 control patients), the urine trypsinogen-2 dipstick test was positive before the 24th hour of hospitalization (sensitivity, 92%; specificity, 65%). The positive predictive value and negative predictive value were 61% and 93%, respectively. Four patients with severe AP had positive results before the 24th hour of admission (80%), including the 2 patients who died (100%). In conclusion, the urinary trypsinogen-2 dipstick seems to have better diagnostic characteristics when it is applied during the early stages of disease. However, the specificity of the test is unsatisfactory. To improve specificity, it may be possible to consider a higher cutoff value for detection of trypsinogen in urine.