Introduction: Acute pancreatitis (AP) is an inflammatory condition having varied presentation from a mild self-limiting to a severe disease with multi organ failure. Trypsinogen-2 is an enzyme secreted from pancreas remains elevated for longer in patients with acute pancreatitis and is excreted out in higher concentration in urine. The aim of the study was to determine predictive and prognostic role of urinary trypsinogen-2 (UT2) levels in AP. Methods: Serial estimation of UT2 levels in patient with AP and other causes acute abdomen were estimated at the time of admission, 3, 7 and 14 days respectively. The values of UT2 levels were correlated with Ransons`s score, Apache score, CT severity index and patient developing local and systemic complications. UT2 levels (µU/ml) were measured using quantitative immune-enzymometric assay kit. Statistical Analysis done on SPSS (Windows version 21.0) Results: The mean UT2 levels were significantly high in patients of AP as compared to other acute abdominal conditions and healthy individuals (mean 13.72 vs 2.07 µ/ml. p< 0.001). The peak levels of UT2 were observed on the first day of mild and severe AP. The mean UT2 levels in mild diseases (n=25 patients) were 3.2-10.1 µU/ml and 11.2-20.2 µU/ml in severe AP (n=52) who also experienced severe local complications and worse outcome. The UT2 levels returned to normal levels within 7-10 days in mild but were persistently raised in severe disease. Conclusion: The higher UT2 levels were indicator of severe diseases, worse outcome and can be a simple and effective prognostic marker.