Lempinen et al studied the ability of several tests to identify patients with severe acute pancreatitis. Patients with severe pancreatitis are managed better in the intensive care unit (ICU), while patients with mild to moderate disease can be managed on a regular hospital ward. The authors are from Helsinki University Cenral Hospital in Finland.
Tests used to assess a patient:
(1) urinary trypsinogen-2 (serum trypsinogen-2 level is also elevated)
(2) urinary trypsinogen activation peptide (TAP, amino-terminal peptide released on activation of trypsinogen to trypsin)
(3) serum C-reactive peptide (CRP)
(4) APACHE II score
Timing of assessments:
(1) on admission
(2) at 24 hours after admission (vs 48 hours for Ranson score)
Test
Mild to Moderate Pancreatitis
Severe Pancreatitis
urinary trypsinogen-2
<= 3,000 µg/L
> 3,000 ¨g/L
urinary TAP
<= 35 nmol/L
> 35 nmol/L
serum CRP
<= 150 mg/L
>= 150 mg/L
APACHE II
<= 8
> 8
The tests have only poor to fair sensitivity, while specificity is fair to good (Table 1, page 269). This means that no single test can be used to stratify a patient. For example, the admission urinary trypsinogen-2 misses 28% of patients with severe pancreatitis and misclassifies 19% of patients who do not need to be admitted to the ICU.
Test
Youden Index on Admission
Youden Index at 24 Hours
urinary trypsinogen-2
0.53
0.60
urinary TAP
0.46
0.46
serum CRP
0.22
0.56
APACHE II
0.16
0.25
where:
• Youden index = S + E - 1, with 1.0 indicating a perfect test and 0 a useless test.
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