Impact of renal dysfunction on the diagnosis of acute pancreatitis using urinary trypsinogen‐2: A retrospective study

• Published in: Nephrology (Carlton, Vic.) Vic.), 2024-06, Vol.29 (6), p.338-343
• Main Authors: Sato, Yuko, Inokuchi, Ryota, Yamamoto, Miyuki, Horie, Ryohei, Asada, Toshifumi, Matsubara, Takehiro, Doi, Kent
• Format: Article
• Language: English
• Subjects: Acute Disease; acute pancreatitis; Adult; Aged; biomarker; Biomarkers; Biomarkers - blood; Biomarkers - urine; Blood levels; Blood Urea Nitrogen; Creatinine; Diagnosis; Early Diagnosis; Female; Glomerular Filtration Rate; Humans; Male; Middle Aged; Pancreatitis; Pancreatitis - blood; Pancreatitis - diagnosis; Pancreatitis - urine; Patients; Predictive Value of Tests; Renal function; Retrospective Studies; Sensitivity analysis; Trypsin - blood; Trypsin - urine; Trypsinogen; Trypsinogen - blood; Trypsinogen - urine
• ISSN: 1320-5358; 1440-1797; 1440-1797
• DOI: 10.1111/nep.14276

Aim Early diagnosis of acute pancreatitis is crucial, and urinary trypsinogen has been recently reported as a useful biomarker for diagnosing acute pancreatitis. We aimed to evaluate the impact of renal dysfunction on the diagnostic performance of urinary trypsinogen‐2 for acute pancreatitis. Methods We conducted a retrospective study using the clinical data of patients who visited the Department of Emergency and Critical Care at the University of Tokyo Hospital between 1 October, 2021, and 30 June, 2022. Patients with available data on qualitative urinary trypsinogen‐2 levels were identified. We compared the urinary trypsinogen‐2 levels among patients who were clinically diagnosed with acute pancreatitis. We further stratified the patients according to renal function parameters, such as serum creatinine level, blood urea nitrogen level, and estimated glomerular filtration rate, and evaluated the performance of urinary trypsinogen‐2 as a biomarker for acute pancreatitis. Results Within 9 months, 35 patients were identified. Of them, 22 patients showed positive results and 13 showed negative results on the urinary trypsinogen‐2 test. The sensitivity, specificity, positive predictive value, and negative predictive value were 0.80, 0.40, 0.18, and 0.92, respectively. Based on the blood urea nitrogen level and estimated glomerular filtration rate, the prevalence of false‐positive results was significantly higher in patients with reduced renal function than in those with normal renal function. Conclusion In patients with reduced renal function, the urinary trypsinogen‐2 qualitative test results might be interpreted with caution when used for diagnosing acute pancreatitis. Summary at a glance Early diagnosis of acute pancreatitis is crucial. Although previous studies reported that urinary trypsinogen‐2 is a useful biomarker for diagnosis, the validity of the qualitative urinary trypsinogen‐2 test in diagnosing renal dysfunction remains unknown. In patients with reduced renal function, qualitative urinary trypsinogen‐2 test may produce false positive results.