In Search for a Better Marker of Acute Pancreatitis—Third Time Lucky?

Although several biomarkers of acute pancreatitis are currently defined, most are nonspecific, and their clinical performance has been disappointing. An article by Oiva et al. in the current issue of Clinical Chemistry describes the development of a specific assay for trypsinogen-3, a new biomarker that shows promise for the diagnosis of this condition (1). Acute pancreatitis accounts for >200 000 hospital admissions in the US every year (2). It carries a substantial mortality rate. Overall, about 20% of patients with acute pancreatitis have a severe course, and 10% to 30% of those with severe acute pancreatitis die. Despite the improvements in intensive care treatment during the past few decades, the death rate has not declined appreciably (3).The clinical diagnosis of acute pancreatitis remains a challenge. Patients typically present with abdominal pain that is commonly associated with nausea and vomiting. These symptoms are nonspecific, however, and their onset depends on the underlying pathology (4). Not only do laboratory investigations augment the diagnosis of acute pancreatitis, they also form part of the diagnostic criteria and several scoring systems that determine the severity of the presentation. More than 100 years ago, the recommendation was to look for the presence of free fat and muscle fibers in the stools to assist in the diagnosis (5). The measurement of amylase and/or lipase, which are released from acinar cells, currently forms the cornerstone of routine diagnostic laboratory investigations (6). Of these assays, the relatively inexpensive serum amylase assay is the most widely used. Many conditions that might present with similar clinical symptoms are also associated with increased amylase concentrations. These conditions include cholecystitis, intestinal obstruction or ischemia, peptic ulcer disease, appendicitis, and gynecologic presentations. Serum amylase may also be increased in extra-abdominal states, such as pathologies of the salivary gland, …