Meta-Analysis
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World J Gastroenterol. Jul 28, 2013; 19(28): 4607-4615
Published online Jul 28, 2013. doi: 10.3748/wjg.v19.i28.4607
Prediction of the severity of acute pancreatitis on admission by urinary trypsinogen activation peptide: A meta-analysis
Wei Huang, Kiran Altaf, Tao Jin, Jun-Jie Xiong, Li Wen, Muhammad A Javed, Marianne Johnstone, Ping Xue, Christopher M Halloran, Qing Xia
Wei Huang, Tao Jin, Ping Xue, Qing Xia, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Kiran Altaf, Li Wen, Muhammad A Javed, Marianne Johnstone, Christopher M Halloran, NIHR Liverpool Pancreas Biomedical Research Unit, Royal Liverpool University Hospital, University of Liverpool, Liverpool L69 3GA, United Kingdom
Jun-Jie Xiong, Department of Hepato-Biliary-Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Huang W and Altaf K contributed equally to this work; Xue P, Halloran CM and Xia Q designed the research, corrected and approved the manuscript; Huang W and Altaf K developed the literature search and carried out statistical analysis of the studies; Jin T, Xiong JJ, Wen L, Javed MA and Johnstone M performed data extraction; Huang W and Altaf K wrote the manuscript; and all authors read and approved the final manuscript.
Supported by Technology Supported Program of Sichuan Province, No. 2011SZ0291; the National Natural Science Foundation of China, No. 81072910; and National Institute for Health Research, United Kingdom
Correspondence to: Ping Xue, MD, PhD, Sichuan Provincial Pancreatitis Center, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Guoxue Rd 37, Chengdu 610041, Sichuan Province, China. sppc.wch.scu@gmail.com
Telephone: +86-28-85423373 Fax: +86-28-85423373
Received: March 16, 2013
Revised: May 20, 2013
Accepted: June 19, 2013
Published online: July 28, 2013
Abstract

AIM: To undertake a meta-analysis on the value of urinary trypsinogen activation peptide (uTAP) in predicting severity of acute pancreatitis on admission.

METHODS: Major databases including Medline, Embase, Science Citation Index Expanded and the Cochrane Central Register of Controlled Trials in the Cochrane Library were searched to identify all relevant studies from January 1990 to January 2013. Pooled sensitivity, specificity and the diagnostic odds ratios (DORs) with 95%CI were calculated for each study and were compared to other systems/biomarkers if mentioned within the same study. Summary receiver-operating curves were conducted and the area under the curve (AUC) was evaluated.

RESULTS: In total, six studies of uTAP with a cut-off value of 35 nmol/L were included in this meta-analysis. Overall, the pooled sensitivity and specificity of uTAP for predicting severity of acute pancreatitis, at time of admission, was 71% and 75%, respectively (AUC = 0.83, DOR = 8.67, 95%CI: 3.70-20.33). When uTAP was compared with plasma C-reactive protein, the pooled sensitivity, specificity, AUC and DOR were 0.64 vs 0.67, 0.77 vs 0.75, 0.82 vs 0.79 and 6.27 vs 6.32, respectively. Similarly, the pooled sensitivity, specificity, AUC and DOR of uTAP vs Acute Physiology and Chronic Health Evaluation II within the first 48 h of admission were found to be 0.64 vs 0.69, 0.77 vs 0.61, 0.82 vs 0.73 and 6.27 vs 4.61, respectively.

CONCLUSION: uTAP has the potential to act as a stratification marker on admission for differentiating disease severity of acute pancreatitis.

Keywords: Acute pancreatitis, Urinary trypsinogen activation peptide, C-reactive protein, Acute Physiology and Chronic Health Evaluation II score, Meta-analysis

Core tip: Currently, the assessment of acute pancreatitis severity on admission remains a challenge to clinicians. A single, rapid biochemical marker is the preferred choice than clinical and computed tomography scoring systems. In this study, the value of urinary trypsinogen activation peptide (uTAP), on admission, in predicting severity of acute pancreatitis was assessed. It was found that the ability of uTAP to predict severity of acute pancreatitis on admission was comparable to C-reactive protein (at 48 h) and was potentially better than the Acute Physiology and Chronic Health Evaluation II score (at 48 h), the most frequently used biochemical marker and clinical scoring system in acute pancreatitis, respectively.