Urinary trypsinogen-2 dipstick test for point-of-care screening of acute pancreatitis


  • Bhuvaneswari Raja Department of Emergency Medicine, Narayana Health City, Bengaluru, Karnataka, India
  • Srinath Kumar T. S. Department of Emergency Medicine, Narayana Health City, Bengaluru, Karnataka, India
  • Viju Wilben V. Department of Emergency Medicine, Narayana Health City, Bengaluru, Karnataka, India




Bed-side, Diagnostic, Pancreatitis, Trypsinogen-2


Background: Acute pancreatitis (AP) is associated with high mortality in its severe form. Conventional laboratory tests used in its diagnosis are fraught with multiple shortcomings. Early institution of intravenous fluid resuscitation can reduce morbidity and mortality. Measurement of urinary trypsinogen-2 using a bedside urine dipstick test may prove useful in early identification of AP.

Methods: Patients with symptoms consistent with AP, attending the emergency department, at a tertiary care hospital in southern India, between November 2014 and November 2016, were included in a prospective observational study. The patients underwent routine investigations and additionally were tested with a urinary trypsinogen-2 dipstick test (UTT). The diagnostic performance and the time to reporting of the different investigations were compared with those of UTT. Final diagnosis of AP, made by clinicians, served as the standard.

Results: The sensitivities of serum amylase, serum lipase, UTT, ultrasonography (USG) and contrast-enhanced computed tomography (CECT) were 97.1%, 94.1%, 92.7%, 98.3% and 100%, respectively. The respective specificities were 92.4%, 98.5%, 98.5%, 100% and 100%. The average time required to obtain the test report was about half hour from admission in case of UTT, compared to about 3 hours for serum amylase/lipase, 4 hours for USG and 6 hours for CECT.

Conclusions: The results indicate that UTT test, due to its high performance indices, simplicity and faster availability of reports, can serve as an ideal screening test for AP and help in early institution of treatment.


Bruno MJ. Improving the Outcome of Acute Pancreatitis. Dig Dis. 2016;34(5):540-5.

Fisher JM, Gardner TB. The “Golden Hours” of Management in Acute Pancreatitis. Am J Gastroenterol. 2012;107(8):1146-50.

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. 2012;62(1):102-11.

Sarr MG. 2012 revision of the Atlanta Classification of acute pancreatitis. Pol Arch Intern Med. 2013;123(3):118-24.

Munoz A, Katerndahl DA. Diagnosis and management of acute pancreatitis. Am Fam Physician. 2000;62(1):164–74.

Simoes M, Alves P, Esperto H, Canha C, Meira E, Ferreira E, et al. Predicting Acute Pancreatitis Severity: Comparison of Prognostic Scores. Gastroenterol Res. 2011;4(5):216-22.

Shah A, Gupta A, Ded K. Assessment of PANC3 score in predicting severity of acute pancreatitis. Niger J Surg. 2017;23(1):53-7.

Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400.

Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatol. 2013;13(4 Suppl 2):e1-e15.

Nesvaderani M, Eslick GD, Cox MR. Acute pancreatitis: update on management. Med J Australia. 2015;202(8):420-3.

Jin T, Huang W, Jiang K, Xiong JJ, Xue P, Javed MA, et al. Urinary trypsinogen-2 for diagnosing acute pancreatitis: a meta-analysis. Hepatobiliary Pancreat Dis Int. 2013;12(4):355-62.

Kemppainen EA, Hedström 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.

Sáez JCBA, Martínez J, Trigo C, Sánchez-Payá J, Compañy L, Laveda R, et al. Clinical value of rapid urine trypsinogen-2 test strip, urinary trypsinogen activation peptide, and serum and urinary activation peptide of carboxypeptidase B in acute pancreatitis. World J Gastroenterol. 2005;11(46):7261.

Kylänpää-Bäck ML, Kemppainen E, Puolakkainen P, Hedström J, Haapiainen R, Korvuo A, et al. Comparison of urine trypsinogen-2 test strip with serum lipase in the diagnosis of acute pancreatitis. Hepatogastroenterol. 2002;49(46):1130-4.

Abraham P. Point-of-care urine trypsinogen-2 test for diagnosis of acute pancreatitis. J Assoc Physicians India. 2011;59:231-2.

Jang T, Uzbielo A, Sineff S, Naunheim R, Scott MG, Lewis LM. Point-of-care Urine Trypsinogen Testing for the Diagnosis of Pancreatitis. Acad Emerg Med. 2007;14(1):29-34.

Kamer E, Unalp HR, Derici H, Tansug T, Onal MA. Early diagnosis and prediction of severity in acute pancreatitis using the urine trypsinogen-2 dipstick test: A prospective study. World J Gastroenterol. 2007;13(46):6208.

Zarnescu NO, Barbu ST, Zarnescu (Vasiliu) EC, Costea R, Neagu S. Management of Acute Pancreatitis in the Early Stage. Mædica. 2015;10(3):257-63.

Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007;75(10):1513-20.

Phillip V, Steiner JM, Algül H. Early phase of acute pancreatitis: Assessment and management. World J Gastrointest Pathophysiol. 2014;5(3):158-68.

Kemppainen E, Hietaranta A, Puolakkainen P, Hedström J, Haapiainen R, Stenman UH. Time Course Profile of Serum Trypsinogen-2 and Trypsin-2-a1-Antitrypsin in Patients with Acute Pancreatitis. Scandinavian journal of gastroenterology. 2000;35(11):1216-20.

Kylänpää‐Bäck ML, Kemppainen E, Puolakkainen P, Hedström J, Haapiainen R, Perhoniemi V, et al. Reliable screening for acute pancreatitis with rapid urine trypsinogen‐2 test strip. British journal of surgery. 2000;87(1):49-52.

Lempinen M, Kylänpää-Bäck ML, Stenman UH, Puolakkainen P, Haapiainen R, Finne P, et al. Predicting the severity of acute pancreatitis by rapid measurement of trypsinogen-2 in urine. Clinical chemistry. 2001;47(12):2103-7.

Pezzilli R, Morselli-Labate AM, d'Alessandro A, Barakat B. Time-course and clinical value of the urine trypsinogen-2 dipstick test in acute pancreatitis. European journal of gastroenterology & hepatology. 2001;13(3):269-74.

Lempinen M, Stenman UH, Finne P, Puolakkainen P, Haapiainen R, Kemppainen E. Trypsinogen-2 and trypsinogen activation peptide (TAP) in urine of patients with acute pancreatitis. J Surg Res. 2003;111(2):267-73.

Chen YT, Chen CC, Wang SS, Chang FY, Lee SD. Rapid urinary trypsinogen-2 test strip in the diagnosis of acute pancreatitis. Pancreas. 2005;30(3):243-7.

Mayumi T, Inui K, Maetani I, Yokoe M, Sakamoto T, Yoshida M, et al. Validity of the urinary trypsinogen-2 test in the diagnosis of acute pancreatitis. Pancreas. 2012;41(6):869-75.




How to Cite

Raja, B., T. S., S. K., & V., V. W. (2019). Urinary trypsinogen-2 dipstick test for point-of-care screening of acute pancreatitis. International Journal of Research in Medical Sciences, 7(5), 1822–1827. https://doi.org/10.18203/2320-6012.ijrms20191684



Original Research Articles