Kwiatek-Średzińska KA, Trochimczyk K, Jamiołkowski J, Lebensztejn DM. Urinary trypsinogens and trypsinogen activation peptide as biomarkers in pediatric acute pancreatitis: A prospective observational study. World J Gastroenterol 2026; 32(40): 119619 [DOI: 10.3748/wjg.119619]
Corresponding Author of This Article
Kamila A Kwiatek-Średzińska, MD, Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Waszyngtona Street 17, Bialystok 15-274, Poland. kamila.kwiatek-sredzinska@umb.edu.pl
Research Domain of This Article
Gastroenterology & Hepatology
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research-article
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World J Gastroenterol. Oct 28, 2026; 32(40): 119619 Published online Oct 28, 2026. doi: 10.3748/wjg.119619
Urinary trypsinogens and trypsinogen activation peptide as biomarkers in pediatric acute pancreatitis: A prospective observational study
Kamila A Kwiatek-Średzińska, Kinga Trochimczyk, Jacek Jamiołkowski, Dariusz M Lebensztejn
Kamila A Kwiatek-Średzińska, Kinga Trochimczyk, Dariusz M Lebensztejn, Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Bialystok 15-274, Poland
Jacek Jamiołkowski, Department of Population Medicine and Lifestyle Diseases Prevention, Medical University of Bialystok, Bialystok 15-269, Poland
Author contributions: Kwiatek-Średzińska KA performed the research, wrote the manuscript; Kwiatek-Średzińska KA, Trochimczyk K and Jamiołkowski J analyzed the data; Kwiatek-Średzińska KA and Lebensztejn DM designed the research study; Lebensztejn DM critically revised the manuscript; all authors have read and approved the final manuscript.
AI contribution statement: ChatGPT was used for language polishing and writing assistance. ChatGPT was used for writing assistance to improve spelling and grammar. The scientific content was prepared by the authors based on the revisions made to the manuscript. AI-generated suggestions were verified by the authors. Data analyses were performed only by the authors. No AI tool participated in design of the study or interpretation of its results.
Supported by Medical University of Bialystok, Poland, No. SUB/1/DN/22/002/1143 and No. B.SUB.26.422.
Institutional review board statement: The study was approved by the Bioethics Committee of the Medical University of Bialystok (approval No. R-I-002/299/2019).
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: The datasets generated and analyzed during the current study are not publicly available due to patient confidentiality, but are available from the corresponding author on reasonable request.
Corresponding author: Kamila A Kwiatek-Średzińska, MD, Department of Pediatrics, Gastroenterology, Hepatology, Nutrition, Allergology and Pulmonology, Medical University of Bialystok, Waszyngtona Street 17, Bialystok 15-274, Poland. kamila.kwiatek-sredzinska@umb.edu.pl
Received: February 12, 2026 Revised: April 20, 2026 Accepted: June 3, 2026 Published online: October 28, 2026 Processing time: 212 Days and 17.7 Hours
Abstract
BACKGROUND
The natural history of acute pancreatitis (AP) in children remains poorly understood, and no reliable noninvasive biomarkers are available to predict progression to severe disease. Studies in adults suggest the usefulness of trypsinogens and trypsinogen activation peptide (TAP) as biomarkers in AP.
AIM
To evaluate the predictive value of urinary trypsinogen-1, trypsinogen-2, and TAP in pediatric AP.
METHODS
This observational study included 61 children with AP hospitalized at the Department of Gastroenterology over a 5-year period and 29 controls with functional abdominal pain. In patients with AP, urinary trypsinogen-1, trypsinogen-2, and TAP were measured at three time points: at admission or within 24 hours, after 48 hours, and after 72 hours of hospitalization. Their predictive value for disease severity was compared with that of serum C-reactive protein (CRP), using receiver operating characteristic analysis and univariate logistic regression.
RESULTS
AP was classified as mild in 49 patients and moderately severe in 12 patients. Urinary trypsinogen-2 after 48 hours was higher in AP than controls (P = 0.022). Moderately severe AP was associated with higher urinary TAP after 48 hours (P = 0.043) and 72 hours (P = 0.001), and higher serum CRP after 48 hours (P = 0.002) and 72 hours (P < 0.001). Receiver operating characteristic analysis showed moderate to good diagnostic performance for TAP and CRP after 48 hours and 72 hours, with area under the curve values ranging from 0.692 to 0.857 (95%CI: 0.542-0.998). Logistic regression revealed that TAP after 72 hours (odds ratio = 1.034, 95%CI: 1.009-1.059) and CRP after 48 hours and 72 hours predicted AP severity.
CONCLUSION
Urinary trypsinogen-2 may serve as a noninvasive biomarker of AP, whereas TAP may be a useful indicator of disease severity in children.
Core Tip: This is the first observational study in children evaluating the usefulness of urinary trypsinogens and trypsinogen activation peptide as biomarkers in pediatric acute pancreatitis. Urinary trypsinogen-2 may serve as a noninvasive biomarker of acute pancreatitis, whereas urinary trypsinogen activation peptide may reflect disease severity in children, although with certain time-dependent limitations. Assessment of urinary parameters offers a simple, noninvasive, and painless approach with potential clinical utility.
