Urinary trypsinogen‐2 level and local complications of acute pancreatitis.

Background and Aim: Local complications of acute pancreatitis (AP) carry risks of morbidity/mortality. This study aimed to assess whether urinary trypsinogen‐2 levels and Bedside Index for Severity in Acute Pancreatitis (BISAP) score on admission predicted subsequent local complications. Methods: One hundred and forty‐four consecutive patients with AP were prospectively followed till 6 months after discharge. Urinary trypsinogen‐2 levels were measured within 24 h of admission. Local complications (acute peripancreatic fluid collection, acute necrotic collection, pseudocyst, and walled‐off necrosis) were diagnosed by abdominal computed tomography. Cut‐off for trypsinogen‐2 level was assessed using receiver operating characteristic curve, and predictors of local complications were analyzed by logistic regression. Results: Thirty‐seven (25.7%) patients developed local complications. Urinary trypsinogen‐2 levels were significantly higher in patients with local complications compared with those without local complications (median [interquartile range], 3210 [620–9764.4] μg/L vs 627.3 [72.3–5895] μg/L, P = 0.006). Urinary trypsinogen‐2 significantly outperformed BISAP score in predicting local complications (area under the receiver operating characteristic curve 0.65 [95% CI: 0.55–0.75] vs 0.48 [95% CI: 0.38–0.58], P = 0.005). At the optimal cut‐off of 500 μg/L, the sensitivity, specificity, positive predictive value, and negative predictive value of trypsinogen‐2 level were 78.4%, 45.8%, 33.3%, and 86.0%, respectively. Urinary trypsinogen‐2 level > 500 μg/L was an independent predictor of local complications (adjusted odds ratio, 3.72; 95% CI: 1.42–9.76; P = 0.007). By contrast, BISAP score ≥ 3 and pleural effusion predicted organ failure but not local complications. Conclusion: In a prospective cohort, urinary trypsinogen‐2 level > 500 μg/L independently predicted local complications of AP. [ABSTRACT FROM AUTHOR]