Validity of the Urinary Trypsinogen-2 Test in the Diagnosis of Acute Pancreatitis

Abstract

A simple urinary trypsinogen-2 test was evaluated for the diagnosis of acute pancreatitis. This prospective multicenter study enrolled consecutive patients with acute abdominal pain who presented to the emergency department or who were hospitalized at 1 of 21 medical institutions in Japan. Patients were tested with urinary trypsinogen-2 dipstick test and a quantitative trypsinogen-2 assay, and these values were compared with serum amylase and lipase findings. A total of 412 patients were enrolled. The trypsinogen-2 dipstick test was positive in 107 of 156 patients with acute pancreatitis (sensitivity, 68.6%) and in 33 of 256 patients with nonpancreatic abdominal pain (specificity, 87.1%). The sensitivity for the diagnosis of pancreatitis caused by alcohol and gallstones by the dipstick test was 72.2% and 81.8%, respectively, which was much higher than those associated with amylase testing. There are several degrees of positivity within the urinary trypsinogen-2 dipstick test. Modification of the cutoff point such that positive (+) and most positive (++) results were interpreted as a positive result, the specificity and positive likelihood ratio increased to 92.2% and 7.63, respectively. This simple, rapid, easy, and noninvasive urinary trypsinogen-2 test can diagnose or rule out most cases of acute pancreatitis.