Prognostic markers and assessment of a previously published clinical severity index in 109 hospitalised dogs with acute presentation of pancreatitis

Utility of 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin)-ester-lipase for monitoring dogs with chronic pancreatitis

BACKGROUND

The utility of 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin)-ester-(DGGR)-lipase activity (DLA) in monitoring clinical progression of chronic pancreatitis (CP) in dogs is unknown.

OBJECTIVE

To examine the association of DLA with clinical signs of CP, as assessed by a CP clinical severity score (CPCSS).

ANIMALS

Twenty-four dogs.

METHODS

This is a retrospective study. Chronic pancreatitis was diagnosed based on clinical signs and DLA > 250 U/L and monitored using CPCSS and DLA.

RESULTS

The study included 134 visits (median, 10 visits/dog; range, 2-11). Mild-moderate (CPCSS, 0-3) and severe (CPCSS, ≥4) disease were documented in 94 (70%) and 40 (30%) visits, respectively. In emergency visits (n = 44; 33%) CPCSS (median, 5; range, 0-15) and DLA (median, 534 U/L; range, 63-7133) were higher (P < .001 and P = .003, respectively) than in scheduled ones (n = 90; 67%; median, 1; range, 0-6 and median, 384 U/L; range, 49-3747, respectively). DGGR-lipase activity was associated (P = .009) with the CPCSS, with a lower activity documented in mild-moderate CPCSS (median 391 U/L; range, 49-3747), compared to severe score (median, 558 U/L; range, 63-7133). DGGR-lipase activity was significantly, but weakly, correlated with CPSS (r = 0.233, P = .007). DGGR-lipase activity inefficiently discriminated mild-moderate vs severe CP (area under the receiver operator characteristics curve, 0.64; 95% confidence interval, 0.53-0.75; P = .012), with DLA cutoff of 428 U/L corresponding to sensitivity of 65% and specificity of 63%.

CONCLUSIONS AND CLINICAL IMPORTANCE

Increased DLA is associated with emergency revisits in dogs with CP, possibly reflecting acute flare-ups. DGGR-lipase activity was associated with the CPCSS over the follow-ups but could not differentiate disease severity.

Prognostic Role of Red Cell Distribution Width and Other Routine Clinico-Pathological Parameters in Dogs with Acute Pancreatitis

This study aimed to assess the prognostic value of red cell distribution width (RDW) RDW-to-calcium ratio (RDW/Ca), neutrophils-to-lymphocytes ratio (N/L), platelets-to-lymphocytes ratio (P/L) and other easy to obtain and inexpensive hematological and biochemical parameters in dogs with acute pancreatitis. This is a multicenter, retrospective cohort study including 70 client-owned dogs. The accuracy of clinical and laboratory variables to predict short-term death (i.e., dead by 14 days) was tested by calculating the area under the receiver-operating characteristic curve (AUC). Independent predictors of death were identified using the multivariable Cox proportional hazards regression model. The survival rate was 72.9% (51 dogs) and 19 dogs died within 14 days of admission from AP. RDW and blood urea nitrogen (BUN) had good accuracy to predict short-term dead with AUC of 0.74 and 0.70 at the cut-off of >12.7% and >42 mg/dL, respectively. According to the multivariable model, RDW (hazard ratio and 95% confidence interval [HR, 95% CI] = 5.08, 95% CI = 1.14−22.67; p = 0.03), BUN (HR = 1.00, 95% CI = 1.00−1.01; p < 0.01) and bilirubin (HR = 2.46, 95% CI = 1.38−4.39; p < 0.01) were independent predictors of death. The results indicate that RDW, BUN and bilirubin are useful predictors of short-term death in dogs with acute pancreatitis.

Progression of lipase activity and pancreatic lipase immunoreactivity in dogs hospitalized for acute pancreatitis and correlation with clinical features

BACKGROUND

Lipase activity and pancreatic lipase immunoreactivity (PLI) have not been compared in dogs hospitalized for acute pancreatitis (AP).

OBJECTIVES

To describe the progression of lipase activity and PLI, and correlations with clinicopathologic features in dogs with AP.

ANIMALS

Thirty-nine dogs with AP based on clinical signs and lipase activity >350 U/L (reference interval [RI], 24-108 U/L).

METHODS

Retrospective study. Lipase activity (LIPC Roche), PLI (SpecPL), and clinical signs were recorded daily. Admission (d1) data (clinical, laboratory, and ultrasound [US] findings), and clinical signs during hospitalization (d2-d3) were assessed for correlation with lipases.

RESULTS

Median (range) duration of clinical signs before presentation was 2 days (1-7 days). Median (range) lipase activity and PLI at d1 were 1070 U/L (range, 357-1500 U/L) and 1111 μg/L (range, 292-1500 μg/L). Strong correlation between assays at d1 (r_s 0.96; P < .0001; n = 39), remained equally strong on d2 (r_s 0.964; P < .0001; n = 39), and d3 (r_s 0.966; P < .0001; n = 22). On d2, lipase activity and PLI were within RI in 13/39 (33%) and 18/39 (46%) of cases. Lipase activities were minimally increased (median, 124 U/L) in 5 dogs with d2 PLI <200 μg/L. On d3, 4 more dogs had normal lipase activity and PLI, and the nature and magnitude of change were always the same for both assays. Clinical signs were not associated with lipases. Only a hyperechoic mesentery, but not an US diagnosis of AP, correlated significantly with lipase activity and PLI.

CONCLUSIONS AND CLINICAL IMPORTANCE

Lipase decreases rapidly to near or within RI within 2 days of treatment in the majority of dogs with AP. Both lipase assays yielded virtually identical results. Mesenteric echogenicity may be an early marker of AP in dogs.

Cardiovascular abnormalities in dogs with acute pancreatitis

BACKGROUND

The prevalence and clinical importance of cardiac abnormalities in dogs with acute pancreatitis (AP) is unknown.

ANIMALS

Twelve dogs with AP and 60 archived serum samples from dogs with suspected AP.

METHODS

Two-phase study.

PHASE I

Analysis of archived serum samples from dogs with clinical signs of AP and high Spec cPL concentrations. High sensitivity troponin I (TnIH) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations were measured in achieved serum samples.

PHASE II

Prospective observational study. Dogs with AP underwent echocardiography and Holter monitoring. Serum cardiac troponin I (cTnI) and plasma NT-proBNP concentrations were measured. Previously described disease severity indices were calculated for each dog.

RESULTS

Phase I: 41 of 60 dogs suspected of having AP had abnormally high TnIH concentrations and 13 of 60 had abnormally high serum NT-proBNP concentrations. Higher TnIH concentrations were observed in dogs with Spec cPL concentration >2000 μg/L as compared to those with concentrations of 1000-2000 μg/L.

PHASE II

11 of 12 dogs diagnosed with pancreatitis had abnormal cTnI concentrations (median: 0.384 ng/mL, range: 0.041-2.966 ng/mL, RI: ≤0.06 ng/mL) and 7 of 12 dogs had plasma NT-proBNP concentrations above the reference interval (median: 971 pmol/L, range: 250-2215 pmol/L, RI: ≤900 pmol/L). Supraventricular and ventricular ectopic beats occurred in 3 dogs. Echocardiographic abnormalities were detected in 5 dogs. Cardiovascular variables were not associated with indices of disease severity.

CONCLUSIONS AND CLINICAL IMPORTANCE

Myocardial injury is common in dogs with AP, but clinical consequences appeared to be uncommon in our small cohort. Cardiac biomarkers should be interpreted with caution in dogs with AP.

Risk Factors and Clinical Presentation in Dogs with Increased Serum Pancreatic Lipase Concentrations—A Descriptive Analysis

Simple Summary

Over the past several years, there has been an increasing importance placed on clinical presentation as part of a diagnosis of pancreatitis, and yet there is comparatively little data investigating the full array of clinical signs that may be seen in dogs with pancreatitis. Our study showed that dogs with increased pancreatic lipase immunoreactivity concentrations could display a wide range of clinical signs, which may be related to pancreatitis or a concurrent disease. Non-specific clinical signs, such as anorexia, were prevalent. Additionally, overt abdominal pain was infrequently reported, and veterinarians should be cautious in ruling out pancreatitis due to a lack of abdominal pain alone. Additionally, limited data is available on potential risk factors for pancreatitis in dogs; this information could be important in the development of disease prevention strategies. In our study, the most common concurrent disease was hepatobiliary abnormalities. Additional studies are needed to determine whether this is a causative or associative relationship. Drug use reflected common prescribing practices, and anti-epileptic drug use was low despite prior studies documenting clear associations between phenobarbital and potassium bromide and drug-associated pancreatitis. Adult maintenance diets, in addition to human foods and dog treats, were commonly fed prior to the development of an increased pancreatic lipase concentration.

Abstract

Limited data exist regarding the full array of clinical signs seen in dogs with pancreatitis and potential risk factors for the disease. Laboratory submissions from the Gastrointestinal Laboratory at Texas A&M University were retrospectively reviewed for dogs with an increased serum pancreatic lipase immunoreactivity (cPLI) concentration (≥400 µg/L), and an internet-based survey was distributed to the attending veterinarian and/or technician on each case. The survey contained questions related to (i) clinical signs, (ii) prior gastrointestinal upset, (iii) comorbidities, (iv) pre-existing medical therapies, and (v) dietary history. One hundred and seventy (170) survey responses were recorded. The top three clinical signs reported were inappetence (62%), diarrhea (53%), and vomiting (49%). Abdominal pain was noted in only 32% of dogs, likely associated with poor pain detection. Additionally, the majority of dogs (71%) had prior episodes of gastrointestinal upset within the past 12 months, lending support for the commonality of recurrent acute pancreatitis, or acute on chronic disease. Hepatobiliary abnormalities (24%) were the most common concurrent disease, and endocrine disorders were seen in a low proportion of respondents (5–8%). Adult maintenance diets (65%), dog treats (40%), and human foods (29%) were commonly consumed by dogs prior to the discovery of increased cPLI concentration.

Effects of medical history and clinical factors on serum lipase activity and ultrasonographic evidence of pancreatitis: Analysis of 234 dogs

Background

Lipase measurements and ultrasonographic (US) evidence of pancreatitis correlate poorly.

Objectives

Identify explanations for discrepant lipase and pancreatic US results.

Animals

Two hundred and thirty‐four dogs with gastrointestinal signs.

Methods

A retrospective study was conducted, in which lipase activity and US were performed within 30 hours. Medical history, clinical examination results, lipase activity, and US results were recorded.

Results

Lipase and US results were weakly correlated (r_s = .25, P < .001). At both evaluated time cut‐offs, median lipase activities were significantly higher with shorter durations of clinical signs before presentation (≤2 days, 334 U/L; >2 days, 118 U/L; P = .03; ≤7 days, 334 U/L; >7 days, 99 U/L; P = .004), but US was not significantly more frequently positive. For both cut‐offs (>216/≤216 U/L, >355/≤355 U/L; reference range, 24‐108 U/L), median disease duration was significantly shorter (3 vs 4 days) with higher lipases. Previous pancreatitis episodes were significantly associated with an US diagnosis of pancreatitis (P = .04), but median lipase activities were not significantly higher (386 U/L vs 153 U/L; P = .06) in these dogs. Pancreatic US was significantly more often positive when the request contained “suspicion of pancreatitis” (P < .001) or “increased lipase” (P = .01). Only changes in pancreatic morphology, echogenicity, and peripancreatic mesentery were significantly associated with a positive US diagnosis, and also had significantly higher lipase activities.

Conclusions and Clinical Importance

Duration of clinical signs before presentation differently affects laboratory and US evidence of pancreatitis. Previous pancreatitis episodes and information given to radiologists influence US results. These findings can be helpful for future studies on pancreatitis in dogs.

Prevalence of ultrasonographic gastrointestinal wall changes in dogs with acute pancreatitis: A retrospective study (2012-2020)

Background

Ultrasonographic gastrointestinal wall changes in dogs with acute pancreatitis (AP) are not well characterized in the literature. No detailed studies have described their prevalence, characteristics, distribution, or clinical relevance.

Hypothesis/Objectives

Describe the prevalence of ultrasonographic gastrointestinal wall changes in a population of dogs with AP and evaluate for associations between the presence of gastrointestinal wall changes and clinical or clinicopathological variables.

Animals

Referral population of 66 client‐owned dogs with AP.

Methods

Retrospective search of clinical records to identify dogs with AP. Clinical variables, clinicopathological variables and ultrasonographic findings were reported using descriptive statistics. A binary logistic regression model was used to evaluate for associations between the presence of gastrointestinal wall changes and clinical or clinicopathological variables.

Results

Sixty‐six dogs were included. Forty‐seven percent of dogs (95% confidence interval [CI], 35.0%‐59.0%; n = 31) with AP had ultrasonographic gastrointestinal wall changes. Gastrointestinal wall changes were most common in the duodenum and identified in 71% (n = 22) of affected dogs. Of dogs with gastrointestinal wall changes, 74.2% (n = 23) had wall thickening, 61.3% (n = 19) had abnormal wall layering, and 35.5% (n = 11) had wall corrugation. In the multivariable model, only heart rate remained an independent predictor of ultrasonographic gastrointestinal wall changes (P = .02).

Conclusions and Clinical Importance

Ultrasonographic gastrointestinal wall changes in this population of dogs with AP were common. Increased heart rate was the only independent predictor of gastrointestinal wall changes, which might imply more severe disease. Additional studies are required to elucidate whether ultrasonographic gastrointestinal wall changes reflect disease severity in AP.

Protease inhibitors, inflammatory markers, and their association with outcome in dogs with naturally occurring acute pancreatitis

Background

Acute pancreatitis (AP) presumably is associated with pancreatic protease activation, protease inhibitor (PI) depletion, and inflammatory mediator secretion.

Objectives

Examine PIs and inflammatory mediator concentrations in dogs with AP and their association with death.

Animals

Thirty‐one dogs diagnosed with AP based on clinical signs, ultrasonographic findings, and increased canine pancreatic lipase immunoreactivity (cPLI) and 51 healthy control dogs.

Methods

Antithrombin and α₂‐antiplasmin activity (ATA and α₂AP, respectively) and concentrations of α₁‐proteinase inhibitor (α₁PI), α₂‐macroglobulin (α₂MG), C‐reactive protein (CRP), interleukins (ILs)‐2,6,8 and tumor necrosis factor‐α (TNF‐α) were prospectively measured. Severity of AP was assessed by clinical severity scoring systems.

Results

Mortality rate was 19%. Antithrombin activity was lower (P = .004) and maximal CRP, IL‐6, and TNF‐α concentrations higher (P < .04) in the AP group compared to the controls, whereas IL‐2, IL‐8, α₁PI, and α₂AP concentrations did not differ between groups. Serum α₂MG concentration was not reliably detected. Serum cPLI, CRP, and IL‐6 concentrations were significantly and positively correlated. The ATA was lower (P = .04), and canine acute pancreatitis severity (CAPS) scores higher (P = .009) in nonsurvivors compared to survivors. Higher CAPS scores were associated (P < .05) with decreased ATA and increased cPLI, CRP, and IL‐6 concentrations.

Conclusions and Clinical Importance

Systemic inflammation in dogs with AP is manifested by increased inflammatory mediator concentrations, correlating with cPLI and CRP concentrations. Hypoantithrombinemia is associated with death. Serum concentrations of α₂AP and α₁PI are less useful prognostic markers. The CAPS score is a useful prognostic marker in dogs with AP.

Pulmonary complications in dogs with acute presentation of pancreatitis

Background

In humans, respiratory complications in patients with acute pancreatitis (AP) are a common life-threatening comorbidity. Since possible lung impairment has not been individually evaluated in canine AP, the aims of the present study were to: (1) describe the prevalence, types and severity of pulmonary complications in dogs with acute presentation of AP, and (2) evaluate their association with mortality. AP diagnosis was based on compatible clinical and laboratory parameters, abnormal canine pancreatic-lipase test, and positive abdominal ultrasound within 48 h from admission. The canine acute pancreatitis severity score (CAPS) was calculated for each dog at admission. Arterial blood gas analysis and thoracic radiography were performed at admission. Thoracic radiography was classified on the basis of pulmonary pattern (normal, interstitial or alveolar) and a modified lung injury score (mLIS) was applied to the ventrodorsal projections for each dog. VetALI/VetARDS were diagnosed using current veterinary consensus. Dogs were divided into non-survivors or survivors (hospital discharge). Clinical, radiological and blood gas parameters collected at presentation were compared between survivors and non-survivors and associated with mortality.

Results

This prospective cohort study included twenty-six client-owned dogs with AP. Twelve out of twenty-six dogs (46%) died or were euthanized. At admission, thirteen dogs showed respiratory distress at physical examination, which was associated with death (P < 0.001). Radiographic abnormalities were found in twenty-one dogs: alveolar (n = 11) and interstitial pattern (n = 10). Radiographic alterations and mLIS score were both associated with death (P = 0.02 and P = 0.0023). The results of the arterial blood-gas evaluation showed that non-survivors had lower PaCO₂ and HCO₃⁻ levels, and higher A-a gradient than survivors (P = 0.0014, P = 0.019 and P = 0.004, respectively). Specifically, three dogs had aspiration pneumonia, and VetALI was diagnosed in nine dogs (34.6%), and no dogs met the criteria for VetARDS. The presence of VetALI was associated with mortality (P < 0.001).

Conclusions

As with humans, possible lung impairments, such as VetALI, should be investigated in dogs with acute presentation of pancreatitis.