A comparative analysis of urine trypsinogen-2 test strip with serum lipase in diagnosis of acute pancreatitis in emergency set-up

Background: Acute pancreatitis possess difficulty in diagnosis in its emergency presentation. Hence to segregate this disease is important from other specific or non-specific causes of acute abdomen. Hence in suspected cases in majority of patients the urinary trypsinogen-2 test strip (Actim pancreatitis) can be used to detect this disease, especially in emergency set-up. The result of the strip test is then corroborated with findings of serum lipase in the blood.Methods: Author prospectively compared 205 consecutive patients with acute abdominal pain admitted to the casualty, SCB Medical College and Hospital. The patients were tested on admission with the Actim pancreatitis test strip. Serum amylase, serum lipase, and urine trypsinogen-2 concentrations were also determined quantitatively.Results: The Actim pancreatitis test strip was sensitive in 93% cases and specific in 92% cases. This was superior to that of serum lipase (sensitivity 77% and specificity 87%). With a cut-off >3x the upper reference limit, the sensitivity of serum lipase was only 52% while the specificity was 98%. The high sensitivity for the Actim pancreatitis test strip resulted in every high negative predictive value of 99%.Conclusions: In patients with acute abdominal pain seen in emergency department, a negative dipstick for urinary trypsinogen-2 rules out acute pancreatitis with high degree of probability and therefore appears to be more suitable for screening of acute pancreatitis. With its high specificity with a cut-off >3x the upper reference limit, serum lipase is suitable as a confirmatory test for pancreatitis when a positive dipstick result is obtained.

Download Full-text

The Role of Routine Assays of Serum Amylase and Lipase for the Diagnosis of Acute Abdominal Pain

Annals of The Royal College of Surgeons of England ◽

10.1308/003588409x392135 ◽

2009 ◽

Vol 91 (5) ◽

pp. 381-384 ◽

Cited By ~ 21

Author(s):

Paul A Sutton ◽

David J Humes ◽

Gemma Purcell ◽

Janette K Smith ◽

Frances Whiting ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Serum Amylase ◽

Reference Range ◽

Acute Abdominal Pain ◽

Clinical Suspicion ◽

University Teaching ◽

Data Set ◽

Serum Lipase

INTRODUCTION We aimed to evaluate the role of routine measurements of serum amylase and lipase in the diagnosis of acute abdominal pain. PATIENTS AND METHODS We identified all patients who had serum amylase and lipase assays over a 62-day period at a single university teaching hospital and reviewed their case notes. RESULTS We excluded 58 of the 1598 patients on grounds of ineligibility (< 18 years of age and those transferred from other hospitals). A complete data set was obtained for 1520 (98.7%) of the remaining 1540 patients. Only 9.1% of requests were based on a clinical suspicion of acute pancreatitis. Of the 44 (2.9%) patients who had acute pancreatitis, only 28 (63.6%) had an associated rise in serum amylase and/or lipase 3 times above the maximum reference range, the remainder being diagnosed radiologically. At this cut-off range, the sensitivity and specificity for serum amylase were 50% and 99%, and those for serum lipase 64% and 97%, respectively. CONCLUSIONS Routine measurements of serum amylase and lipase are unhelpful in the diagnosis of acute abdominal pain unless there is clinical suspicion of acute pancreatitis. In these patients, assay of lipase alone is preferable to assay of amylase alone or both enzymes.

Download Full-text

Assays of serum lipase: analytical and clinical considerations.

Clinical Chemistry ◽

10.1093/clinchem/32.7.1290 ◽

1986 ◽

Vol 32 (7) ◽

pp. 1290-1302 ◽

Cited By ~ 52

Author(s):

J A Lott ◽

S T Patel ◽

A K Sawhney ◽

S C Kazmierczak ◽

J E Love

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Comparative Method ◽

Analytical Sensitivity ◽

Serum Lipase ◽

Clinical Sensitivity ◽

Reference Limit ◽

Analytical Properties ◽

Clinical Considerations ◽

Upper Reference Limit

Abstract We evaluated three commercially available methods for determining lipase (EC 3.1.1.3) in serum--the Du Pont aca, Boehringer Mannheim Diagnostics (BMD), and Kodak Ektachem (EK) procedures--for their analytical properties and diagnostic efficiencies. Titrimetry was used as the comparative method. The BMD and EK methods showed better agreement with the titrimetric method, owing to the presence of the necessary cofactor, colipase, in their reagents. Colipase also increased the analytical sensitivity of the BMD and EK procedures as compared with the aca method. Determinations of serum lipase, by all methods, had a clinical sensitivity in excess of 80% for acute pancreatitis; the specificity of the lipase test was about 60%, or twice that of serum amylase. Serum lipase determinations with the current, simpler technology are superior to total amylase in the diagnosis of patients with acute pancreatitis. When a colipase-supplemented method is used, a serum lipase value greater than 10-fold the upper reference limit appears to be pathognomonic for acute pancreatitis or inflammation of organs close to the pancreas.

Download Full-text

A comparative analysis of urine trypsinogen-2 test strip with serum lipase and serum amylase in diagnosis of acute pancreatitis

International Surgery Journal ◽

10.18203/2349-2902.isj20213969 ◽

2021 ◽

Vol 8 (10) ◽

pp. 2921

Author(s):

Satish Kumar R. ◽

Ashik Aslam ◽

Nitish S. ◽

Gagan S. Prakash

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

High Sensitivity ◽

Test Strip ◽

Serum Lipase ◽

Emergency Presentation ◽

High Negative Predictive Value ◽

Set Up ◽

High Degree ◽

Symptoms And Signs

Background: Acute pancreatitis possess difficulty in diagnosis in its emergency presentation. Hence segregation of this disease from other specific or non-specific causes of acute abdomen is important. In majority of the suspected cases, the urinary trypsinogen-2 test strip can be used to detect this disease, especially in emergency set-up. The aim and objective of the study was to evaluate the sensitivity and specificity of urinary trypsinogen-2 and to compare it with that of the standard biochemical markers of acute pancreatitis serum amylase and serum lipase.Methods: All patients who presented to the surgical emergency with symptoms and signs suspicious of acute pancreatitis were included in the study, rapid urinary trypsinogen-2 test was done immediately at the bed side, serum amylase and lipase was send for all cases along with routine investigations.Results: The urinary trypsinogen-2 test was sensitive in 96.1% cases and specific in 82.6% cases. The sensitivity is superior to that of serum lipase (sensitivity-90.2%) and serum amylase (sensitivity-84.3%). The high sensitivity of the urinary trypsinogen-2 test resulted in very high negative predictive value of 90.5%, hence a negative test almost rules out the diagnosis of acute pancreatitis.Conclusions: In patients with acute abdominal pain with suspicion of acute pancreatitis seen in emergency department, a negative dipstick for urinary trypsinogen-2 rules out acute pancreatitis with high degree of probability and therefore appears to be more suitable for screening of acute pancreatitis.

Download Full-text

Ceftriaxone-Induced Acute Pancreatitis

Annals of Pharmacotherapy ◽

10.1177/106002809302700108 ◽

1993 ◽

Vol 27 (1) ◽

pp. 36-37 ◽

Cited By ~ 18

Author(s):

Anthony E. Zimmermann ◽

Brian G. Katona ◽

Joginder S. Jodhka ◽

Richard B. Williams

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Acute Abdominal Pain ◽

Signs And Symptoms ◽

Etiologic Agent ◽

Antibiotic Regimen ◽

Intravenous Injections ◽

Case Summary ◽

Catheter Sepsis ◽

History Of

OBJECTIVE: To report a case of probable ceftriaxone-induced acute pancreatitis. CASE SUMMARY: A patient with a history of short-bowel syndrome on home total parenteral nutrition developed fever, chills, and right flank pain. She was diagnosed with gram-negative catheter sepsis and prescribed antibiotic therapy to be administered for four weeks. After completion of the first week of therapy, the antibiotic regimen was changed to intravenous injections of ceftriaxone to be given daily at home. Prior to discharge the patient developed acute abdominal pain, leukocytosis, jaundice, and markedly elevated lipase and amylase concentrations consistent with acute pancreatitis. The patient's condition improved upon discontinuation of the ceftriaxone and the remainder of her stay was uneventful. DISCUSSION: There is only one other case report in the literature of probable ceftriaxone-induced pancreatitis. Multiple other medications have been implicated in causing acute pancreatitis. The exact mechanism of this uncommon adverse effect of ceftriaxone is unknown. CONCLUSIONS: There was a temporal relationship between the development of this patient's signs and symptoms and the administration of ceftriaxone. We could not identify any other factors that may have been responsible for the development of her acute pancreatitis. Ceftriaxone should be considered as a possible etiologic agent in patients who present with acute abdominal pain and elevated lipase and amylase concentrations.

Download Full-text

Acute Pancreatitis: An Atypical Presentation

Case Reports in Gastroenterology ◽

10.1159/000475920 ◽

2017 ◽

Vol 11 (2) ◽

pp. 359-363 ◽

Cited By ~ 1

Author(s):

Omar Nadhem ◽

Omar Salh

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Reports ◽

Case Series ◽

Normal Serum ◽

Intravenous Fluids ◽

Serum Enzyme ◽

Serum Lipase ◽

Upper Abdominal ◽

Symptoms And Signs

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

Download Full-text

Comparison of urine trypsinogen-2 test strip with serum lipase in the diagnosis of acute pancreatitis

Gastroenterology ◽

10.1016/s0016-5085(00)82722-5 ◽

2000 ◽

Vol 118 (4) ◽

pp. A162 ◽

Cited By ~ 1

Author(s):

Marja-Leena Kylanpaa-Back ◽

Esko Kemppainen ◽

Pauli A. Puolakkainen ◽

Johan Hedstrom ◽

Reijo Haapiainen ◽

...

Keyword(s):

Acute Pancreatitis ◽

Test Strip ◽

Serum Lipase

Download Full-text

Man with epigastric pain and persistently elevated serum lipase

BMJ Case Reports ◽

10.1136/bcr-2019-229208 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229208

Author(s):

Caroline Annette Erika Bachmeier ◽

Adam Morton

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Epigastric Pain ◽

Elevated Serum ◽

Pancreatic Disease ◽

Radiological Assessment ◽

Serum Lipase ◽

Persistent Elevation ◽

Assay Interference ◽

Laboratory Assay

Serum lipase and amylase are commonly requested in individuals presenting with abdominal pain for investigation of acute pancreatitis. Pancreatic hyperenzymaemia is not specific for acute pancreatitis, occurring in many other pancreatic and non-pancreatic conditions. Where persistent elevation of serum lipase and amylase occurs in the absence of a diagnosed cause or evidence of laboratory assay interference, ongoing radiological assessment for pancreatic disease is required for 24 months before a diagnosis of benign pancreatic hyperenzymaemia can be made. We report a case of a 71-year-old man with epigastric pain and elevated serum lipase levels. He was extensively investigated, but no pancreatic disease was detected. He is asymptomatic, but serum lipase levels remain elevated 18 months after his initial presentation.

Download Full-text

Case Report: Acute Abdominal Pain as Presentation of Pneumonia and Acute Pancreatitis in a Pediatric Patient With COVID-19

JPGN Reports ◽

10.1097/pg9.0000000000000011 ◽

2020 ◽

Vol 2 (1) ◽

pp. e011

Author(s):

Raul E. Sanchez ◽

Colleen B. Flahive ◽

Ethan A. Mezoff ◽

Cheryl Gariepy ◽

W. Garrett Hunt ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Case Report ◽

Pediatric Patient ◽

Acute Abdominal Pain

Download Full-text

Insights into Acute Pancreatitis Associated COVID-19: Literature Review

Journal of Clinical Medicine ◽

10.3390/jcm10245902 ◽

2021 ◽

Vol 10 (24) ◽

pp. 5902

Author(s):

Yasameen E. Muzahim ◽

David C. Parish ◽

Hemant Goyal

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Respiratory Symptoms ◽

Clinical Symptoms ◽

Pancreatic Injury ◽

Insufficient Data ◽

Converting Enzyme ◽

Serum Lipase ◽

Asymptomatic Patients ◽

Organ Systems

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) primarily affects the lungs, causing respiratory symptoms. However, the infection clearly affects all organ systems including the gastrointestinal system. Acute pancreatitis associated with coronavirus disease 2019 (COVID-19) has been widely reported Recent studies have discussed pancreatic compromise incidentally in asymptomatic patients, or in a form of clinical symptoms such as abdominal pain, nausea, or vomiting, which is further reflected in some cases with abnormal serum lipase and amylase levels It was suggested that upregulation of angiotensin-converting enzyme II cell receptors or inflammatory cytokines play a major role in predisposing pancreatic injury in SARS-CoV-2 positive patients To date, there is insufficient data to establish the causality of acute pancreatitis in SARS-CoV-2 infected cases. In this paper, we organize recent studies conducted to observe the frequency of acute pancreatitis associated with COVID-19 cases while highlighting present hypotheses, predisposing factors, and their effect on the outcome, and point to gaps in our knowledge.

Download Full-text

Systemic lupus erythematosus-related acute pancreatitis

Lupus ◽

10.1177/0961203320978515 ◽

2020 ◽

Vol 30 (1) ◽

pp. 5-14

Author(s):

Alina Dima ◽

Daniel Vasile Balaban ◽

Ciprian Jurcut ◽

Mariana Jinga

Keyword(s):

Systemic Lupus Erythematosus ◽

Acute Pancreatitis ◽

Abdominal Pain ◽

Plasma Exchange ◽

Lupus Erythematosus ◽

High Dose ◽

Systemic Lupus ◽

Serum Lipase ◽

Autoimmune Pathology ◽

Short Disease Duration

Introduction Systemic lupus erythematosus (SLE) is a complex autoimmune pathology that can involve any organ. Lupus-related acute pancreatitis (AP) is, together with lupus mesenteric vasculitis, an important cause of SLE-induced acute abdominal pain. Methods A literature search was conducted using the terms “Pancreatitis” and “Lupus Erythematosus, Systemic” on PubMed/Medline and Web of Science from January 2007 to January 2020. Clinical characteristics, diagnostic approach, and treatment principles in SLE-related AP are presented in this review. Results Mainly retrospective reports were identified. The reported incidence of SLE-associated AP ranges from 0.9 to more than 5% of patients. A total of 264 SLE patients were found in the selected research, with a net female predominance (sex ratio 9:1) and mean age of 31.4 years. Abdominal pain was virtually present in all cases. AP occurrence was more frequent in SLE patients with short disease duration, high activity scores, and multiorgan involvement. The AP definition was based on currently available guidelines and after exclusion of any other known causes (including iatrogenic, i.e. drugs), a diagnosis of “idiopathic” SLE-related AP might be sustained. Management is difficult, as there is no standardized therapeutic approach. Of note, glucocorticoid use remains still controversial as, especially for high doses, subsequent pancreatic injury may occur. Monitoring serum lipase levels after high dose steroids might be considered. One study reported beneficial prognostic effect of plasma exchange. Moreover, AP in SLE might raise awareness about macrophage activation syndrome association. Mortality up to one third of AP cases in SLE was reported. Conclusion The SLE-related AP is a rare, but severe, life-threatening complication. Corticosteroids must be used with caution. Plasma exchange could be considered in selected cases.

Download Full-text