Objective: To investigate the value of urinary trypsi-nogen activation peptide (TAP) in the early prediction of severe acute pancreatitis and to compare it with acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ).
Methods: We assessed the predictive value of urinary TAP concentrations measured by a competitive enzyme-linked immunosorbent assay. Urine samples were collected for detecting TAP concentrations at admission, and 24, 48, and 72 h from 41 patients with acute pancreatitis (12 with severe disease, 29 with mild disease) who presented within 48 h the onset of symptoms and from 11 control patients, while APACHE Ⅱ scores were recorded at 48 h after admission.
Results: The peak median urinary TAP concentration was seen at admission. The median urinary TAP concentration at admission for severe pancreatitis (95 nmol/L) was significantly higher than the median for patients with mild pancreatitis (20 nmol/L, P<0.005) and controls (15 nmol/L, P<0.005). TAP concentrations were significantly higher in patients with severe acute pancreatitis than the median in patients with mild pancreatitis (P<0.05) and controls (P<0.05) on days 2 to 3. The median APACHE Ⅱ scores of severe patients were significantly different from those of mild patients (10.5 vs 6.0, P<0.01). The sensitivity, specificity, positive predictive, and negative predictive values of an admission urinary TAP≥35 nmol/L for severe pancreatitis were 91.7%, 89.7%, 78.6% and 96.3%, whereas 48 h after admission the values for APACHE Ⅱ scores (≥9) were 75.0%, 72.7%, 52.9% and 87.5%. In prediction of disease severity, the urine TAP concentration was much better than APACHE Ⅱ at 48 h.
Conclusions: Urinary TAP obtained at the first 48 h of the onset of symptoms can predict severe acute pancreatitis. In prediction of disease severity, the urinary TAP is much better than APACHE Ⅱ score.