Published: 2021-09-28

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

Satish Kumar R., Ashik Aslam, Nitish S., Gagan S. Prakash


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.


Acute pancreatitis, Acute abdomen, Serum amylase, Serum lipase, Urine trypsinogen-2

Full Text:



Tietz NW, Shuey DF. Lipase in serum--the elusive enzyme: an overview. Clin Chem. 1993;39(5):746-56.

Wong EC, Butch AW, Rosenblum JL. The clinical chemistry laboratory and acute pancreatitis. Clin Chem. 1993;39(2):234-43.

Robinson LA, Kim WJ, White TT, Hadorn B. Trypsin in human pancreatic juice--their distributions as found in 34 specimens. Two human pancreatic trypsinogens. Scand J Gastroenterol. 1972;7(1):43-5.

Hedstrom J, Sainio V, Kemppainen E, Puolakkainen P, Haapiainen R, Kivilaakso E, et al. Urine trypsinogen-2 as marker of acute pancreatitis. Clin Chem. 1996;42(5):685-90.

Steer ML. Frank Brooks memorial Lecture: The early intraacinar cell events which occur during acute pancreatitis. Pancreas. 1998;17(1):31-7.

Figarella C, Amouric M, Guy CO. Enzyme activation and liberation: intracellular/extracellular events. Acute pancreatitis. Berlin: Springer; 1987: 53-60.

Hedstrom J, Korvuo A, Kenkimaki P, Tikanoja S, Haapiainen R, Kivilaakso E, et al. Urinary trypsinogen-2 test strip for acute pancreatitis. Lancet. 1996;347(9003):729-30.

Kemppainen EA, Hedstrom JI, Puolakkainen PA, Sainio VS, Haapiainen RK, Perhoniemi V, et al. Rapid measurement of urinary trypsinogen-2 as a screening test for acute pancreatitis. N Engl J Med. 1997;336(25):1788-93.

Hedstrom J, Sainio V, Kemppainen E, Haapiainen R, Kivilaakso E, Schroder T, et al. Serum complex of trypsin 2 and alpha 1 antitrypsin as diagnostic and prognostic marker of acute pancreatitis: clinical study in consecutive patients. BMJ. 1996;313(7053):333-7.

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.

Norman W, Connel P, McCaskie A. Bailey and Love’s short practice of surgery. 27th ed. India: CRC Press; 2018: 1223.