Trypsin and Trypsinogen Activation Peptide in the Prediction of Severity of Acute Pancreatitis
Abstract
:1. Introduction
2. Single-Center Observational Study
2.1. Methods
2.1.1. Study Design and Population
2.1.2. Clinical Assessment
2.1.3. Assay
2.1.4. Sample Size
2.1.5. Statistical Analysis
2.1.6. Development and Assessment of Prognostic Models
2.1.7. Statistical Software
3. Results
3.1. Patients
3.2. Severity of AP and Biomarker Serum Levels
3.3. Prediction of Organ Failure and Death
4. Systematic Review
4.1. Study Identification, Eligibility and Screening
4.2. Data Extraction and Quality Assessment
5. Findings
5.1. Trypsinogen
5.2. TAP
5.3. Trypsin
6. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic | All Patients (n = 142) | Severe (n = 9) | Moderate (n = 35) | Mild (n = 81) | Missing Data (n = 17) |
Age, years | 57 (44, 72) | 68 (45, 70) | 62 (52, 73) | 55 (39, 73) | 51 (34, 68) |
Female, n (%) | 61 (43) | 3 (33) | 8 (23) | 42 (52) | 8 (47) |
Pregnancy, n (%) | 1 (1) | 0 (0) | 0 (0) | 1 (1) | 0 (0) |
Cause of pancreatitis, n (%) | |||||
Alcoholic | 33 (23) | 5 (56) | 11 (31) | 13 (16) | 4 (24) |
Biliary | 86 (61) | 4 (44) | 17 (49) | 55 (68) | 10 (59) |
Other | 23 (16) | 0 (0) | 7 (20) | 13 (16) | 3 (18) |
History of pancreatitis, n (%) | 26 (18) | 0 (0) | 10 (29) | 13 (16) | 3 (18) |
History of rheumatic disease, n (%) | 9 (6) | 0 (0) | 1 (3) | 6 (7) | 2 (12) |
CT scan, n (%) | 58 (41) | 6 (67) | 24 (69) | 27 (33) | 1 (6) |
Time from study inclusion to CT scan, days | 0 | 0 | 0 | 0 | 0 |
(0, 2) | (0, 1) | (0, 2) | (0, 2) | (0, 0) | |
Findings CT scan a, n (%) | |||||
Normal | 7 (5) | 0 (0) | 3 (9) | 4 (5) | 0 (0) |
Edematous pancreatitis | 48 (34) | 5 (56) | 19 (54) | 23 (28) | 1 (6) |
Pancreatic necrosis | 10 (7) | 4 (44) | 6 (17) | 0 (0) | 0 (0) |
Abscess | 0 (0) | 0 (0) | 0 (0) | 0 (0) | 0 (0) |
Pseudocyst | 5 (4) | 0 (0) | 5 (14) | 0 (0) | 0 (0) |
Bleeding | 2 (1) | 0 (0) | 2 (6) | 0 (0) | 0 (0) |
ERCP b, n (%) | 18 (21) | 1 (25) | 3 (18) | 13 (24) | 1 (10) |
Time from study inclusion to ERCP b, days | 2 | 21 | 2 | 2 | 3 |
(1, 4) | (21, 21) | (1, 10) | (1, 3) | (3, 3) | |
Main Analysis | |||||
Characteristic | All Patients (n = 136) | Organ Failure or Death (n = 29) | No Organ Failure or Death (n = 107) | ||
Age, years | 57 (45, 72) | 65 (49, 76) | 55 (40, 72) | ||
Female sex, n (%) | 56 (41) | 8 (28) | 48 (45) | ||
Cause of pancreatitis, n (%) | |||||
Alcoholic | 33 (24) | 11 (38) | 22 (21) | ||
Biliary | 83 (61) | 15 (52) | 68 (64) | ||
Other | 20 (15) | 3 (10) | 17 (16) | ||
Trypsin c, ng/mL | 2292 (1699, 3046) | 1888 (1600, 2350) | 2459 (1815, 3317) | ||
TAP d, pg/mL | 381 (298, 534) | 348 (292, 448) | 382 (301, 538) | ||
APACHE II f (score) | 6 (4, 8) | 9 (6, 14) | 5 (4, 8) |
Main Analysis | Sensitivity Analysis | |||
Severe (n = 9) Moderate (n = 35) Mild (n = 81) | Ratio of Geometric Means (95% CI) | p-Value | Ratio of Geometric Means (95% CI) | p-Value |
Trypsin a | ||||
Severe vs. mild | 0.72 (0.51, 1.00) | 0.053 | 0.77 (0.55, 1.07) | 0.115 |
Severe vs. moderate | 0.90 (0.63, 1.28) | 0.550 | 1.00 (0.71, 1.41) | 0.989 |
Moderate vs. mild | 0.80 (0.66, 0.96) | 0.019 | 0.77 (0.65, 0.91) | 0.003 |
TAP b | ||||
Severe vs. mild | 0.74 (0.54, 1.01) | 0.055 | 0.73 (0.54, 0.98) | 0.035 |
Severe vs. moderate | 0.72 (0.52, 1.00) | 0.051 | 0.72 (0.53, 0.99) | 0.042 |
Moderate vs. mild | 1.02 (0.86, 1.22) | 0.794 | 1.01 (0.85, 1.19) | 0.948 |
All Patients (n = 136) | ||||
Prognostic Variable | N | OR (95% CI) | p | AUC |
Trypsin (by one SD increase) | 130 | 0.64 (0.41, 0.97) | 0.036 | 0.66 |
TAP (by one SD increase) | 128 | 0.88 (0.56, 1.36) | 0.575 | 0.55 |
APACHE II (by one SD increase) | 134 | 2.76 (1.75, 4.70) | <0.001 | 0.73 |
All Patients (n = 136) | ||||
---|---|---|---|---|
Prognostic Variable | N | OR (95% CI) | p | AUC |
Trypsin (by one SD increase) | 130 | 0.64 (0.41, 0.97) | 0.036 | 0.66 |
TAP (by one SD increase) | 128 | 0.88 (0.56, 1.36) | 0.575 | 0.55 |
APACHE II (by one SD increase) | 134 | 2.76 (1.75, 4.70) | <0.001 | 0.73 |
Publication | Year | AUC | Cut-Off (ug/L) | N (AP) | N (SAP) | Median Conc. SAP (ug/L) | N (MAP) | Median Conc. MAP (ug/L) | Time of Sample Collection | Definition Used for Severity Used |
---|---|---|---|---|---|---|---|---|---|---|
Trypsinogen-2 | ||||||||||
Hedström J | 2001 | 0.792 | 911 | 64 | 21 | 1829 | 43 | 768 | on admission | Atlanta 1992 |
Lempinen M | 2003 | 0.745 | - | 64 | 19 | 2930 | 45 | 1890 | on admission | Atlanta 1992 |
Hedström J | 1996 | 0.744 | - | 110 | 28 | 2251 | 82 | 992 | 0–48 h | According to clinical outcome |
Rainio M | 2019 | 0.726 | 1512 | 239 | 67 | 1186 | 172 | 254 | 0–12 h | Atlanta 2012 |
Hedström J | 1996 | 0.721 | - | 59 | 19 | 1800 | 40 | 1000 | 0–24 h | Major local or systemic complication |
Regnér S | 2008 | - | - | 140 | 16 | 1334 | 124 | 704 | 0–24 h | Atlanta 1992 |
Kemppainen E | 2000 | - | - | 92 | 73 | 2880 | 19 | 923 | on admission | Atlanta 1992 |
Trypsinogen-1 | ||||||||||
Lempinen M | 2003 | 0.768 | 64 | 19 | 350 | 45 | 220 | on admission | Atlanta 1992 | |
Rainio M | 2019 | 0.656 | 1279 | 239 | 67 | 451 | 172 | 316 | 0–12 h | Atlanta 2012 |
Publication | Year | AUC | N (AP) | N (SAP) | Median Conc. (SAP) (nmol/L) | N (MAP) | Median Conc. (MAP) (nmol/L) | Time of Sample Collection | Definition Used for Severity |
---|---|---|---|---|---|---|---|---|---|
Allemann A (Present study) | 2024 | 0.55 | 128 | 26 | - | 102 | On admission | Organ failure or death | |
Lempinen M | 2003 | 0.823 | 64 | 19 | 5 | 45 | 1 | on admission | Atlanta 1992 |
Mayer JM | 2000 | - | 25 | 16 | 1.6 | 9 | 1 | on admission | Atlanta 1992 |
Kemppainen E | 2001 | - | 172 | 35 | - | 137 | - | 0–6 h | Atlanta 1992 |
Pezzilli R | 2004 | 0.253 | 34 | 12 | - | 22 | - | on admission | Atlanta 1992 |
Publication | Year | AUC | N (AP) | N (SAP) | Median Conc. (SAP) | N (MAP) | Median Conc. (MAP) | Time of Sample Collection | Definition Used for Severity |
---|---|---|---|---|---|---|---|---|---|
Allemann A (Present study) | 2024 | 0.66 | 27 | - | 103 | - | On admission | Organ failure or death | |
Hu J | 2018 | - | 140 | 94 | 71–124 nmol/L | 46 | 65 nmol/L | not disclosed | Not disclosed |
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Allemann, A.; Staubli, S.M.; Nebiker, C.A. Trypsin and Trypsinogen Activation Peptide in the Prediction of Severity of Acute Pancreatitis. Life 2024, 14, 1055. https://doi.org/10.3390/life14091055
Allemann A, Staubli SM, Nebiker CA. Trypsin and Trypsinogen Activation Peptide in the Prediction of Severity of Acute Pancreatitis. Life. 2024; 14(9):1055. https://doi.org/10.3390/life14091055
Chicago/Turabian StyleAllemann, Andreas, Sebastian M. Staubli, and Christian A. Nebiker. 2024. "Trypsin and Trypsinogen Activation Peptide in the Prediction of Severity of Acute Pancreatitis" Life 14, no. 9: 1055. https://doi.org/10.3390/life14091055