Correspondence

Measurement of Urinary Trypsinogen-2 as a Screening Test for Acute Pancreatitis

N Engl J Med 1997; 337:1394-1395November 6, 1997

Article

To the Editor:

In describing their comparison of the urinary trypsinogen-2 dipstick test and the serum amylase assay for the diagnosis of acute pancreatitis, Kemppainen et al. (June 19 issue)1 mention the unsatisfactory sensitivity and specificity of both serum amylase and serum lipase determinations. They compared the measurement of urinary trypsinogen-2 with the serum amylase assay but did not mention whether determining serum lipase levels as well would have increased the sensitivity and specificity of a serum-based diagnosis.2 It is well accepted that serum lipase determinations are superior to those of serum amylase, and I wonder why this factor was not considered in their analysis as well.3

Jeffrey A. Grinblatt, M.D.
Rush Medical College, Chicago, IL 60612

3 References

1. 1

   Kemppainen EA, Hedstrom JI, Puolakkainen PA, et al. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. N Engl J Med 1997;336:1788-1793
   Full Text | Web of Science | Medline

2. 2

   Corsetti JP, Cox C, Schulz TJ, Arvan DA. Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis. Clin Chem 1993;39:2495-2499
   Web of Science | Medline

3. 3

   Orebaugh SL. Normal amylase levels in the presentation of acute pancreatitis. Am J Emerg Med 1994;12:21-24
   CrossRef | Web of Science | Medline

Author/Editor Response

The authors reply:

To the Editor: The aim of our study was to validate the new urinary trypsinogen-2 dipstick test as a screening test for acute pancreatitis. As the main point of reference we used the serum amylase assay, which is still the most widely used diagnostic method for acute pancreatitis.1 We also wanted to compare it with another rapid screening method, which detects urinary amylase (Rapignost-Amylase, Boehringer Mannheim, Marburg, Germany). The quantitative urinary trypsinogen-2 assay was used only as a reference method to confirm the technical function of the urinary trypsinogen-2 dipstick. We agree with Dr. Grinblatt that it would have been interesting to compare the results of the urinary trypsinogen-2 dipstick test with serum lipase determinations and lipase and amylase determinations in combination. However, lipase assays are not in routine use in Finland because they are not considered to offer any significant benefits as compared with the serum amylase assay.

Dr. Grinblatt cites the study by Orebaugh,2 which does not offer convincing evidence of the superior diagnostic accuracy of the serum lipase assay as compared with the serum amylase assay. The study was retrospective and included 57 patients, and no diagnostic criteria for acute pancreatitis were defined. In some studies the determination of lipase has shown a somewhat greater diagnostic accuracy,1,3 but in a large study the total amylase level was more accurate than the pancreatic amylase or lipase level.4 Consequently, the usefulness of measuring both lipase and amylase in serum has been considered clinically insignificant.3 Therefore, we think that the use of additional serum assays would not have changed the main findings of our study.

Esko A. Kemppainen, M.D.
Pauli A. Puolakkainen, M.D.
Ulf-Håkan Stenman, M.D.
Helsinki University Central Hospital, 00290 Helsinki, Finland

4 References

1. 1

   Steinberg W, Tenner S. Acute pancreatitis. N Engl J Med 1994;330:1198-1210
   Full Text | Web of Science | Medline

2. 2

   Orebaugh SL. Normal amylase levels in the presentation of acute pancreatitis. Am J Emerg Med 1994;12:21-24
   CrossRef | Web of Science | Medline

3. 3

   Werner M, Steinberg WM, Pauley C. Strategic use of individual and combined enzyme indicators for acute pancreatitis analyzed by receiver-operator characteristics. Clin Chem 1989;35:967-971
   Web of Science | Medline

4. 4

   Clave P, Guillaumes S, Blanco I, et al. Amylase, lipase, pancreatic isoamylase, and phospholipase A in diagnosis of acute pancreatitis. Clin Chem 1995;41:1129-1134
   Web of Science | Medline

Citing Articles (2)

Citing Articles

1. 1

   Peter Jordanov, Georgi Grigorov, Silvia Todorova, Rosen Angov, Vlado Hristov, Mircho Vukov. (2009) Application of an Express Urinary Trypsinogen-2 Test for the Diagnosis of Acute Pancreatitis. Point of Care: The Journal of Near-Patient Testing & Technology 8:1, 21-24
   CrossRef

2. 2

   Chris E. Forsmark, John Baillie. (2007) AGA Institute Technical Review on Acute Pancreatitis. Gastroenterology 132:5, 2022-2044
   CrossRef