URINARY TRYPSINOGEN ACTIVATION PEPTIDE (TAP) PREDICTS SEVERITY IN PATIENTS WITH ACUTE-PANCREATITIS

Conclusions. Urinary TAP obtained within the first 48 h of the onset o f symptoms can distinguish patients with severe acute pancreatitis. Ba ckground. Urinary trypsinogen activation peptide (TAP) has recently be en described as an early marker of severity in acute pancreatitis. Met hods. In a multicenter study, urine samples were collected for TAP con centration at 6-12, 24, and 48 h after admission from 139 patients wit h acute pancreatitis (99 with mild disease, 40 with severe disease) an d from 50 control patients. Severity of acute pancreatitis was defined by the presence of organ failure and/ or pancreatic necrosis on dynam ic contrast-enhanced computed tomography. Results. Median urinary TAP in the 139 patients with acute pancreatitis compared to the 50 control patients was significantly higher at admission, 4.6 vs 0.8 ng/mL (p < 0.001), and 6-12 h, 1.9 vs 0.55 ng/mL (p = 0.04). Among patients who presented within 48 h of the onset of symptoms, the median urinary TAP for severe pancreatitis (9 patients) compared to mild pancreatitis (4 0 patients) was significantly higher at admission, 29.6 vs. 3.6 ng/mL (p = 0.0001). Also, when obtained within 48 h of the onset of symptoms , all patients with severe pancreatitis had an admission urinary TAP l evel > 10 ng/mL. The sensitivity and specificity of an admission urina ry TAP greater than or equal to 10 for severe pancreatitis was 100 and 85%, respectively. Given a cutoff of 10 ng/mL for an admission urinar y TAP obtained within 48 h of the onset of symptoms, the negative pred ictive value was 100% for mild pancreatitis.