Serial monitoring of pancreatic lipase immunoreactivity, C-reactive protein, abdominal ultrasonography, and clinical severity in dogs with suspected pancreatitis

Abstract

Background: Diagnosis of pancreatitis is based on clinical signs, pancreatic lipase immunoreactivity (cPLI), and abdominal ultrasonography (AUS). Diagnostic discrepancies exist between test results which might be related to differences in the timeline for resolution of these abnormalities after pancreatic injury.

Hypothesis/objectives: To evaluate disease severity, ultrasonographic findings, and serum biomarkers of pancreatitis in dogs over a period of 28-days.

Animals: Sixteen client-owned dogs with a clinical suspicion for acute pancreatitis based on history/physical examination, an abnormal SNAP cPLI, and ultrasonographic evidence of pancreatitis.

Methods: Prospective observational study. Clinical severity (modified clinical activity index [MCAI]), cPLI, C-reactive protein (CRP), and AUS were evaluated at days 0, 2, 7, and 28. Owner assessed overall health (OH) was noted. Dogs were stratified into baseline cPLI ≥400 μg/L vs <400 μg/L groups for reporting.

Results: The median CRP, MCAI, and OH were 111.9 mg/L, 10, and 4/10 respectively in the cPLI ≥400 μg/L group. The median CRP, MCAI, and OH were 58.0 mg/L, 6, and 6/10 respectively in the cPLI <400 μg/L group. None of these variables were significantly different between groups. Most dogs (4/5) in the cPLI <400 μg/L group had a history of suspected pancreatitis (ie, suspect acute on chronic disease). cPLI and MCAI rapidly decreased in dogs with a baseline cPLI ≥400 μg/L, whereas sonographic evidence of pancreatitis persisted for a longer time period.

Conclusions and clinical importance: Ultrasonographic evidence of pancreatitis in the absence of overt clinical or biochemical abnormalities might represent a resolving injury rather than active disease.

Keywords: PLI; Spec cPL; immunoassay; monitoring; pancreas; ultrasound.

FIGURE 1

Study timeline. This figure visually outlines the screening criteria and subsequent analyses that were performed at days 0, 2, 7, and 28 post enrollment on each dog in the study.

FIGURE 2

Graphical representation of changes in biochemical values and scoring systems over time. This figure represents changes in biochemical parameters and scoring systems over time in dogs with a high (Spec cPL ≥400 μg/L) and low baseline (Spec cPL < 400 μg/L) pancreatic lipase concentrations. The center point represents the median value, while the lines represent the 95% CI (bootstrap method). Superscript is utilized to indicate statistical significance, a change in superscript letter over time points indicates an adjusted P value <.05. No comparisons in the cPLI <400 μg/L were significant and as such superscript was not added to these values. CRP, C‐reactive protein; MCAI, modified canine activity index; OH, owner assessed overall health; Spec cPL, pancreatic lipase concentration; UPASS, ultrasonographic pancreatic assessment severity score.