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Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study.

AbstractBACKGROUND:
There is a pressing clinical requirement for an early simple test of severity in acute pancreatitis. We investigated the use of an assay of trypsinogen activation peptide (TAP).
METHODS:
We undertook a multicentre study in 246 patients (172 with acute pancreatitis [35 with severe disease], 74 controls). We assessed the predictive value of urinary TAP concentrations measured by a validated competitive immunoassay. We compared the results with those for plasma C-reactive protein and three clinicobiochemical scoring systems. TAP and C-reactive protein concentrations were analysed at set times after symptom onset and compared with the clinicobiochemical systems scores at key times during hospital stay.
FINDINGS:
At 24 h after symptom onset, the median urinary TAP concentration was 37 nmol/L (IQR 17-110) for severe and 15 nmol/L (5-35) for mild disease (p<0.001). The respective values for plasma C-reactive protein were 24 mg/L (3-34) and 25 mg/L (6-75; p=0.208). The sensitivity, specificity, positive predictive, and negative predictive values of the test to show severe acute pancreatitis compared with mild acute pancreatitis at 24 h were: for TAP (>35 nmol/L), 58%, 73%, 39%, and 86%, respectively, and for C-reactive protein (>150 mg/L), 0%, 90%, 0%, and 75%. 48 h after admission the values for the clinicobiochemical scoring systems were: APACHE II (> or =8), 56%, 64%, 30%, and 85%; Ranson score (> or =3), 89%, 64%, 38%, and 96%; and Glasgow score (> or =3), 77%, 75%, 44%, and 93%. At 48 h, the values for C-reactive protein were 86%, 61%, 37%, and 94% and for TAP were 83%, 72%, 44%, and 94%. Combined testing of C-reactive protein and TAP was not superior to TAP alone for accuracy.
INTERPRETATION:
Urinary TAP provided accurate severity prediction 24 h after onset of symptoms. This single marker of severity in acute pancreatitis deserves routine clinical application.
AuthorsJ P Neoptolemos, E A Kemppainen, J M Mayer, J M Fitzpatrick, M G Raraty, J Slavin, H G Beger, A J Hietaranta, P A Puolakkainen
JournalLancet (London, England) (Lancet) Vol. 355 Issue 9219 Pg. 1955-60 (Jun 3 2000) ISSN: 0140-6736 [Print] ENGLAND
PMID10859041 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
Chemical References
  • Oligopeptides
  • trypsinogen activation peptide
  • C-Reactive Protein
Topics
  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • C-Reactive Protein (metabolism)
  • Case-Control Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Oligopeptides (urine)
  • Pancreatitis (classification, metabolism, urine)
  • Predictive Value of Tests
  • Prognosis
  • Severity of Illness Index

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