Urinary Trypsinogen to rule out acute pancreatitis in patients with abdominal pain
Date First Published:
March 1, 2000
Last Updated:
October 8, 2001
Report by:
John Butler, SpR in Emergency Medicine (Manchester Royal Infirmary)
Search checked by:
Magnus Harrison, Manchester Royal Infirmary
Three-Part Question:
In [patients with abdominal pain] is [a urinary trypsinogen test] sufficiently sensitive as a diagnostic marker [to rule in/out pancreatitis]?
Clinical Scenario:
A 45 year old female attends the emergency department with a 4-hour history of acute onset of epigastric pain. She has a history of alcohol usage. On examination you can elicit tenderness in the epigastrium but no peritonism. You are concerned that the patient may have pancreatitis. You wonder whether a urinary trypsinogen can be used as a diagnostic marker to rule out pancreatitis in this patient.
Search Strategy:
Medline 1966-04/2000 and EMBASE using the OVID interface.
Search Details:
[{exp Trypsinogen/ or trypsinogen.mp} AND {exp Urine/ OR urine.mp}] LIMIT to English AND Human.
Outcome:
21 papers were found in total of which 17 were irrelevant or of insufficient quality for inclusion. The remaining 4 papers are shown below.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Urine trypsinogen-2 as marker of acute pancreatitis. Hedstrom J, Sainio V, Kemppainen E, Puolakkainen P, et al. 1996 Finland | 59 patients with pancreatitis 42 controls admitted with abdominal pain |
Diagnostic study looking at ROC curves of urinary trypsinogen, serum trypsinogen, serum amylase and urinary amylase | Diagnosis of pancreatitis | Urinary trypsinogen had similar ROC curve results as serum amylase | Selected patients Gold standard |
| Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis. Tenner S, Fernandez-del Castillo C, Warshaw A et al. 1997 USA | 189 patients; 139 with pancreatitis, 50 without | Diagnostic study looking at urinary trypsinogen as a marker of pancreatic injury compared with CT diagnosis. | Urinary trypsinogen (10 ng/ml) | NPV = 100% | |
| Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. Kemppainen EA, Hedstrom JI, Puolakkainen PA, et al. 1997 Finland | 500 consecutive patients attending A&E in 2 centres with abdominal pain | Diagnostic study to assess the usefulness of urinary trypsinogen as a diagnostic marker. | Urinary trypsinogen (50 ng/ml) | Sensitivity 94% (92-96%); Specificity 95% (93-97%) | Diagnosis based on amylase >900 or clinical + CT scan in patients with normal amylase Autopsy Surgery |
| Serum amylase (300IU) | Sensitivity 85%; Specificity 91% | ||||
| Urinary Amylase (2000IU/L) | Sensitivity 83%; Specificity 88% | ||||
| Reliable screening for acute pancreatitis with rapid urine trypsinogen-2 test strip. Kylanpaa-Back M, Kemppainen E, Puolakkainen P et al. 2000 Finland | 525 consecutive patients with acute abdominal pain presenting to 2 emergency departments Urinary trypsinogen 2 test strip used |
Diagnostic study looking at test strips for urinary trypsinogen and quantitative urinary trypsinogen measurements. Gold standard measurement was clinical features, amylase and CT findings. | Diagnosis of pancreatitis | 45 patients had pancreatitis. Sensitivity 96% (94-97%); Specificity 92% (90-95%). All patients with severe disease were detected. | Gold standard |
Author Commentary:
The diagnosis of pancreatitis often needs to be excluded as a matter of routine in patients who present to the emergency department with acute abdominal pain. The relevant papers demonstrate that pancreatitis can be excluded with a high level of sensitivity by measuring the urinary trypsinogen levels.
Bottom Line:
Urinary trypsinogen can be used as a sensitive diagnostic tool to exclude pancreatitis in patients presenting to the emergency department with abdominal pain.
References:
- Hedstrom J, Sainio V, Kemppainen E, Puolakkainen P, et al.. Urine trypsinogen-2 as marker of acute pancreatitis.
- Tenner S, Fernandez-del Castillo C, Warshaw A et al.. Urinary trypsinogen activation peptide (TAP) predicts severity in patients with acute pancreatitis.
- Kemppainen EA, Hedstrom JI, Puolakkainen PA, et al.. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis.
- Kylanpaa-Back M, Kemppainen E, Puolakkainen P et al.. Reliable screening for acute pancreatitis with rapid urine trypsinogen-2 test strip.