trypsinogen and Abdomen--Acute

To assess a point-of-care urine trypsinogen-2 (UT) test for the diagnosis of acute pancreatitis.. This was a prospective study of patients presenting to the emergency department with abdominal pain suggestive of acute pancreatitis. A 3-minute point-of-care UT test (Actim Pancreatitis; Medix Biochemica, Kauniainen, Finland) was compared with final diagnosis of acute pancreatitis, which was based on suggestive clinical features, serum lipase and/or amylase levels and imaging.. Of 124 patients included in this study, 69 patients had final diagnosis of acute pancreatitis. The sensitivity and specificity of UT were, respectively, 73.9% (95% CI 61.9% to 83.8%) and 94.6% (95% CI 84.9% to 98.9%).. The point-of-care UT test for acute pancreatitis had good sensitivity and specificity, and can be used reliably at the bedside to make a positive diagnosis.

Topics: Abdomen, Acute; Acute Disease; Amylases; Humans; India; Lipase; Pancreatitis; Patients; Point-of-Care Systems; Prospective Studies; Reproducibility of Results; Sensitivity and Specificity; Trypsin; Trypsinogen

Evaluation of a new serum test for diagnosis of acute pancreatitis.. One hundred and sixty-three patients presenting with acute abdominal pain were included into the study. Acute pancreatitis was diagnosed by CT or ultrasound. Serum samples were taken 0-1 days, 2-3 days, and 4-5 days after onset of symptoms and C-reactive protein, lipase, elastase, and amylase were determined. As a further parameter, Pankrin, a newly available kit for the measurement of a mixture of elastase and other pancreatic secretory proteins was used. As control, serum from 558 apparently healthy blood donors was analysed. The receiver operator characteristics (ROC) and the areas under the curves (AUC) were calculated for each individual test.. In Western blot analysis the antibodies of the Pankrin assay detected the majority of protein bands in human pancreatic juice. In blood donors, the median value of Pankrin was 88 U/ml (range 14-316 U/ml). In 16 from 163 patients with acute abdominal pain, acute pancreatitis was diagnosed and the median Pankrin level in samples collected on days 0-1 was 345 U/ml (range 220-518 U/ml, p<0.0001). In those patients with abdominal pain but without pancreatitis, the median was 116 U/ml (range 17-396 U/ml). The ROC-curves for amylase, lipase, elastase, and Pankrin from samples collected after 0-1 days were similar (area under the curves (AUC) >0.98). After 2-3 days, the AUC of all markers decreased (AUC 0.80-0.89) and after 4-5 days the AUC of Pankrin (0.85) was higher than all other parameters.. In those patients with abdominal pain, who present several days after onset of pain, the new serum test for pancreatitis, Pankrin, could be of help to improve the diagnosis of pancreatitis.

Topics: Abdomen, Acute; Abdominal Pain; Amylases; C-Reactive Protein; Enzyme-Linked Immunosorbent Assay; Evaluation Studies as Topic; Humans; Lipase; Pancreatic Elastase; Pancreatic Juice; Pancreatitis; Predictive Value of Tests; Reagent Kits, Diagnostic; Reference Values; ROC Curve; Sensitivity and Specificity; Trypsinogen

Immunoreactive trypsin in serum can be divided into trypsinogen and trypsin-alpha 1-proteinase inhibitor (alpha 1PI) complexes. These were studied separately in serum from 204 patients with acute gastro-intestinal symptoms. Elevated levels of both trypsinogen and trypsin-alpha 1PI complexes were seen in patients with acute pancreatitis. Elevated levels of trypsinogen and normal or slightly elevated levels of trypsin-alpha 1PI complexes were seen in patients with biliary tract diseases. An isolated increase in the concentration of trypsin-alpha 1PI complexes with normal trypsinogen and amylase levels were seen in patients with perforated ulcer. This third cluster may result from an absorption of active trypsin from the peritoneal cavity. Small amounts of trypsin-alpha 1PI complexes were present also in serum from patients free from pancreatic disease. The results in this study show that high levels of trypsin-alpha 1PI complexes in serum are seen mainly in patients with acute pancreatitis. However, elevated levels are also seen in other pathological conditions in the upper gastrointestinal tract; therefore an assay for these complexes is not a specific diagnostic test for acute pancreatitis.

Topics: Abdomen, Acute; alpha 1-Antitrypsin; Biliary Tract Diseases; Gastritis; Humans; Pancreatic Neoplasms; Pancreatitis; Peptic Ulcer; Trypsinogen