Diagnosis of pancreatitis in dogs and cats

Evaluation of the clinical usefulness of pancreatic alpha amylase as a novel biomarker in dogs with acute pancreatitis: a pilot study

Pancreatic alpha amylase (P-AMY) is used as a biomarker of acute pancreatitis (AP) in human medicine. To our knowledge, there are no studies evaluating the usefulness of P-AMY in dogs with AP. In this study, we evaluated the diagnostic value of P-AMY, currently not verified in veterinary medicine. The AP group (n = 40) consisted of dogs with AP diagnosed using clinical signs and laboratory examinations, including abnormal canine pancreatic lipase (cPL) concentration, and compatible abdominal ultrasound examination at first presentation. Evaluation of the canine AP severity (CAPS) score was performed. The control group (n = 38) was composed of normal dogs without any abnormalities in clinical findings, blood exams or diagnostic imaging. The correlation of P-AMY with cPL was confirmed by Pearson's correlation analysis (r = 0.564, p < .001). The sensitivity and specificity for the most appropriate cut-off values of P-AMY were recorded similar to the values of DGGR. The dogs with AP and CAPS ≥11 had significantly higher serum P-AMY (p = .016) contrary to DGGR lipase and cPL. Furthermore, there was a significant difference in the median P-AMY dependent on the presence of systemic inflammatory response syndrome (p = .001). P-AMY showed similar level of diagnostic accuracy along with sensitivity and specificity compared to DGGR lipase. In addition, P-AMY showed a significant association with CAPS score, contrary to cPL and DGGR lipase. Along with other biomarkers associated with AP, P-AMY has the potential of usefulness as a supportive diagnostic and prognostic biomarker of AP in dogs.

A comparative analysis of canine pancreatic lipase tests for diagnosing pancreatitis in dogs

IMPORTANCE

Early diagnosis of canine pancreatitis is challenging due to non-specific clinical signs. Currently, abdominal ultrasonography and measurement of canine pancreatic lipase (cPL) have been employed for the diagnosis of pancreatitis.

OBJECTIVE

Many qualitative and quantitative commercial cPL tests have been developed and used in veterinary clinics. This study aimed to compare three different methodologies SNAP cPL, Spec cPL, and Vcheck cPL tests to assess the concordance of these assays.

METHODS

Fifty serum samples were collected from 36 dogs with or without pancreatitis and subjected to SNAP cPL, Spec cPL, and Vcheck cPL tests. Agreement and correlation coefficients were calculated between the test results, and correlations were determined during the management of the patients.

RESULTS

The results of the three cPL assays were strongly correlated in 47/50 serum samples (94%). Cohen's kappa analysis between the Spec cPL and Vcheck cPL showed near perfect agreement (κ = 0.960, p < 0.001), SNAP cPL and Vcheck cPL (κ = 0.920, p < 0.001), and Spec cPL and SNAP cPL (κ = 0.880, p < 0.001). The correlation coefficients (r) between data from Spec cPL and Vcheck cPL tests was calculated by Spearman's correlation test (r = 0.958, p < 0.001). Furthermore, the patterns of change in serum cPL concentrations determined using Spec cPL and Vcheck cPL were significantly consistent during the monitoring period in 11 patients.

CONCLUSIONS AND RELEVANCE

Our data illustrated that Spec cPL and Vcheck cPL tests are compatible for clinical use in the diagnosis and monitoring of canine pancreatitis.

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

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.

Candidate circulating microRNA biomarkers in dogs with chronic pancreatitis

BACKGROUND

Pancreatitis is an important cause of disease and death in dogs. Available circulating biomarkers are not sufficiently sensitive and specific for a definitive diagnosis.

HYPOTHESIS

Circulating microRNAs would be differentially expressed in dogs with chronic pancreatitis and could have potential as diagnostic biomarkers.

ANIMALS

Healthy controls (n = 19) and dogs with naturally occurring pancreatitis (n = 17).

METHODS

A retrospective case-control study. Dogs with pancreatitis were included if they satisfied diagnostic criteria for pancreatitis as adjudicated by 3 experts. MicroRNA was extracted from stored serum samples and sequenced. Reads were mapped to mature microRNA sequences in the canine, mouse, and human genomes. Differentially expressed microRNAs were identified and the potential mechanistic relevance explored using Qiagen Ingenuity Pathway Analysis (IPA).

RESULTS

Reads mapping to 196 mature microRNA sequences were detected. Eight circulating microRNAs were significantly differentially expressed in dogs with pancreatitis (≥2-fold change and false discovery rate <0.05). Four of these mapped to the canine genome (cfa-miR-221, cfa-miR-222, cfa-miR-23a, and cfa-miR-205). Three mapped to the murine genome (mmu-miR-484, mmu-miR-6240, mmu-miR-101a-3p) and 1 to the human genome (hsa-miR-1290). Expression in dogs with pancreatitis was higher for 7 microRNAs and lower for mmu-miR-101a-3p. Qiagen IPA demonstrated a number of the differently expressed microRNAs are involved in a common pancreatic inflammatory pathway.

CONCLUSIONS

The significantly differentially expressed microRNAs represent promising candidates for further validation as diagnostic biomarkers for canine pancreatitis.

Computed tomographic measurements of pancreatic thickness in clinically normal dogs

Pancreatic thickness is an indicator for evaluating pancreatic diseases. The transverse and cross-sectional pancreatic thickness observed on computed tomography (CT) may differ. This study aimed to provide a normal reference range for pancreatic thickness on the transverse plane based on body weight (BW) and assess pancreatic thickness to aorta (P/Ao) ratio. In addition, we aimed to establish the normal short and long dimensions of the pancreas based on cross-sectional image through the long axis of the pancreas using multiplanar reconstruction (MPR). The short dimension to aorta (S/Ao) and long dimension to aorta (L/Ao) ratios were also established in clinically normal dogs. The pancreatic thickness was measured using CT results of 205 clinically normal dogs. The pancreatic thickness on the transverse plane and the short and long dimensions in the cross-sectional image of the pancreas were measured using MPR. The diameter of the Ao was measured on the transverse plane and the P/Ao, S/Ao, and L/Ao ratios were calculated. Our study showed that the mean normal pancreatic thicknesses (mean ± standard deviation [SD]) of the pancreatic body, left and right lobe in the transverse plane were 10.92 ± 2.54 mm, 8.92 ± 2.26 mm and 9.96 ± 2.24 mm, respectively. The P/Ao ratios of the pancreatic body, left and right lobes were 1.85 ± 0.33, 1.50 ± 0.27 and 1.68 ± 0.29, respectively. The mean short dimension (mean ± SD) in the cross-sectional image of the pancreatic body, left and right lobe were 8.98 ± 1.97 mm, 7.99 ± 1.89 mm and 8.76 ± 2.03 mm, respectively. In conclusion, pancreatic thickness increased with BW, while the P/Ao, S/Ao, and L/Ao ratios could be used regardless of BW.

Assessing primary care veterinarians' use of and confidence in performing point-of-care ultrasound

BACKGROUND

Point-of-care ultrasound (POCUS) is gaining popularity in the veterinary field, but there is little information on operator confidence.

METHODS

A survey was distributed to primary care veterinarians (PCVs) via social media between May and July 2020. Details of participants' training in and use of POCUS were recorded. Participants' confidence in using thoracic and abdominal POCUS was also assessed using a five-point Likert scale.

RESULTS

Two hundred and one PCVs used POCUS, of which 32% reported using a non-standardised protocol. Fifty percent of PCVs were self-taught and 17.4% had attended a specific practical course. The median confidence score was 4 out of 5 (interquartile range [IQR] 2-5) for identifying abdominal abnormalities, irrespective of the training method. The median confidence score for thoracic abnormalities was 3 out of 5 (IQR 1-4) for those taught by a colleague or who were self-taught using journal articles or videos.

LIMITATIONS

The survey-based nature of the study relies on self-reporting and is therefore liable to recall bias.

CONCLUSIONS

PCVs' confidence in using POCUS is lacking, particularly with thoracic POCUS. Standardised practical training for PCVs, particularly in thoracic POCUS, would be beneficial. Future studies should explore how best to deliver this training.

Expression of vitamin D receptor, CYP24A1, and CYP27B1 in normal and inflamed canine pancreases

Vitamin D plays a role in anti-inflammatory processes, and the alteration of its metabolism is associated with the inflammatory processes of pancreatitis. This study was performed to evaluate the expression of the vitamin D receptor (VDR) and the two major enzymes that regulate vitamin D metabolism, 1α-hydroxylase (CYP27B1) and 24-hydroxylase (CYP24A1), in the canine pancreas and to compare their degrees of immunoreactivity between normal and inflamed pancreases. Five normal and inflamed pancreatic tissues each were obtained from six dogs. The expression of VDR, CYP24A1, and CYP27B1 were determined immunohistochemically, and the degree of immunostaining was assessed semiquantitatively. The VDR was expressed in the ducts, acini, and islets of Langerhans of normal pancreases and in the ducts and acini of inflamed ones. There was a significant difference in the immunoreactivity score for VDR in the islets of Langerhans between normal (median, 3 [interquartile range, 2-7.5] score) and inflamed pancreatic tissues (0 [0-0.5] score, p = 0.03). CYP24A1 was expressed in the ducts and islets of Langerhans in both normal and inflamed pancreases, whereas CYP27B1 was expressed in the ducts and acini in only some normal and inflamed pancreatic tissues. This study showed that VDR expression decreased in inflamed pancreases and demonstrated CYP24A1 and CYP27B1 expression in the canine pancreas for the first time. These findings indicate that the pancreas could regulate the metabolism and biological activity of vitamin D and suggest that a decrease in these might be related to the pathophysiology of pancreatitis.

Serum 25-hydroxyvitamin D, vitamin D receptor, and vitamin D binding protein concentrations in dogs with acute pancreatitis compared to healthy control dogs

BACKGROUND

Previous studies have documented vitamin D imbalance in dogs with acute pancreatitis (AP), but no studies have investigated serum vitamin D receptor (VDR) and vitamin D-binding protein (VDBP) concentrations.

OBJECTIVES

Compare serum 25-hydroxyvitamin D (25[OH]D), VDR, and VDBP concentrations in healthy dogs and dogs with AP and identify correlations between these concentrations with ionized calcium, C-reactive protein (CRP), and canine-specific pancreatic lipase (Spec cPL) concentrations.

ANIMALS

Twenty-two dogs with AP and 20 healthy control dogs.

METHODS

Prospective cross-sectional study. Serum 25(OH)D concentrations were measured using a chemiluminescence immunoassay, and VDR and VDBP concentrations were measured using a ELISA kit designed for dogs.

RESULTS

Serum concentrations of 25(OH)D were lower in dogs with AP (mean ± SD, 66.1 ± 39.2 ng/mL) than in controls (96.8 ± 30.4 ng/mL; P = .01), and VDR concentrations were lower in dogs with AP (5.3 ± 3.5 ng/mL) than in controls (7.4 ± 2.5 ng/mL; P = .03). No difference was observed in serum VDBP concentrations between the groups. Serum VDR concentrations differed between survivors (median [interquartile range] = 6.6 [4.3-8.2] ng/mL) and nonsurvivors (2.7 [0.5-3.5] ng/mL; P = .01). Negative correlations were observed among serum VDR, CRP (rs  = -0.55), and Spec cPL (rs  = -0.47) concentrations in dogs with AP.

CONCLUSIONS AND CLINICAL IMPORTANCE

Dogs with AP had lower serum 25(OH)D and VDR concentrations than controls. Additionally, our study suggests a potential role of VDR expression in the inflammatory process of AP in dogs.

Computed tomographic evaluation of pancreatic perfusion in 10 dogs with acute pancreatitis

Severe canine acute pancreatitis can be fatal; imaging features that can predict the clinical course of disease are useful for clinicians. On computed tomography (CT), both pancreatic heterogeneous contrast enhancement and portal vein thrombosis have been correlated with poorer outcome. Perfusion CT is used in human medicine to evaluate pancreatic microcirculation to predict the future development of severe sequela to pancreatitis; this technology has yet to be explored in dogs with acute pancreatitis. The objective of this prospective, case-control study is to evaluate pancreatic perfusion using contrast-enhanced CT in dogs with acute pancreatitis and compare it with previously established values obtained in healthy dogs. Ten client-owned dogs preliminarily diagnosed with acute pancreatitis received a full abdominal ultrasound, specific canine pancreatic lipase (Spec cPL), and perfusion CT. Computer software calculated pancreatic perfusion, peak enhancement index, time to peak enhancement, and blood volume for 3-mm and reformatted 6-mm slices. The data was analyzed using Shapiro-Wilk test, linear mixed model, and Spearman's rho. Values for 3-mm slices were similar to 6-mm slices (all P < 0.05). Dogs with acute pancreatitis had a faster time to peak enhancement than healthy dogs (P = 0.04-0.06). Dogs with acute pancreatitis and homogeneous pancreatic enhancement had higher perfusion, faster time to peak enhancement, and greater blood volume compared to healthy dogs and dogs with acute pancreatitis and heterogeneous pancreatic enhancement (all P = / < 0.05). Pancreatic perfusion decreased with increased pancreatitis severity. No correlation was identified between Spec cPL and pancreatic perfusion (all P > 0.05). These findings preliminarily support perfusion CT in dogs with acute pancreatitis.

Evaluation of red blood cell distribution width, neutrophil-to-lymphocyte ratio, and other hematologic parameters in canine acute pancreatitis

OBJECTIVE

To determine if RBC distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), and other hematological parameters are associated with increased odds of in-hospital mortality, increased length of hospitalization (LOH), or disease severity as measured by the Canine Acute Pancreatitis Severity (CAPS) score in dogs with acute pancreatitis (AP).

DESIGN

Retrospective, multicenter study from January 2016 to August 2020.

SETTING

Four private emergency and specialty referral centers.

ANIMALS

On initial case search, 118 client-owned dogs were identified with a clinical diagnosis of AP. Out of these cases, 114 dogs met inclusion criteria, defined as sudden onset of ≥2 compatible clinic signs (lethargy, anorexia, vomiting, or abdominal pain), a specific canine pancreatic lipase concentration >400 μg/L, hospital admission, as well as CBC and serum biochemistry run within 48 hours of initial hospitalization. Disease severity was calculated and measured using the CAPS score, in addition to LOH and in-hospital mortality.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Clinical endpoints were in-hospital mortality, LOH, and disease severity, as evaluated by the CAPS score. Overall in-hospital mortality was 36.8%. NLR was significantly associated with survival, with a higher percentage being associated with an increased likelihood of nonsurvival (odds ratio: 1.1, 95% confidence interval: 1.0-1.2; P = 0.006, adjusted P = 0.04). Increased NLR was found to be significantly associated with a longer LOH based on the unadjusted P-value (P = 0.02) but was not statistically significant based on a P-value adjusted for multiple comparisons (P = 0.12). No significant associations were noted when RDW, platelet-to-lymphocyte ratio, WBC count, mean platelet volume, RDW-to-platelet ratio, or RDW-to-total serum calcium ratio was evaluated against outcome measures.

CONCLUSIONS

This study retrospectively evaluated the prognostic utility of several readily available hematological parameters in dogs hospitalized for AP. Dogs with an increased NLR may have a higher risk of in-hospital mortality and increased LOH, although future prospective studies are necessary to confirm these findings.

Fecal acute phase proteins in cats with chronic enteropathies

BACKGROUND

Chronic enteropathies (CE) are common in cats and reliable biomarkers that can distinguish different causes and predict or monitor response to treatment are currently lacking.

HYPOTHESIS

To evaluate certain acute phase proteins in feces that could potentially be used as biomarkers in cats with CE.

ANIMALS

Twenty-eight cats with either inflammatory bowel disease (IBD; n = 13), food-responsive enteropathy (FRE; n = 3) or small cell gastrointestinal lymphoma (SCGL; n = 12) and 29 healthy control cats were prospectively enrolled.

METHODS

Fecal concentrations of haptoglobin, alpha-1-acid-glycoprotein (AGP), pancreatitis-associated protein-1 (PAP-1), ceruloplasmin, and C-reactive protein (CRP) were measured using Spatial Proximity Analyte Reagent Capture Luminescence (SPARCL) immunoassays before and after initiation of treatment. Cats were treated with diet and/or prednisolone (IBD cats), plus chlorambucil (SCGL cats).

RESULTS

Compared with controls, median fecal AGP concentrations were significantly lower (25.1 vs 1.8 μg/g; P = .003) and median fecal haptoglobin (0.17 vs 0.5 μg/g), PAP-1 (0.04 vs 0.4 μg/g) and ceruloplasmin (0.15 vs 4.2 μg/g) concentrations were significantly higher (P < .001) in cats with CE. Median fecal AGP concentrations were significantly lower (P = .01) in cats with IBD and FRE (0.6 μg/g) compared with cats with SCGL (10.75 μg/g). A significant reduction was found in CE cats after treatment for median fecal ceruloplasmin concentrations (6.36 vs 1.16 μg/g; P = .04).

CONCLUSIONS

Fecal AGP concentration shows promise to differentiate cats with SCGL from cats with IBD and FRE. Fecal ceruloplasmin concentrations may be useful to objectively monitor response to treatment in cats with CE.

Serum α1-Proteinase Inhibitor, Calprotectin, and S100A12 Concentrations in the Characterization of Pancreatitis in Dogs

Miniature Schnauzers are predisposed to develop pancreatitis, with familial hypertriglyceridemia (HTG) described as a potential risk factor. Diagnosing pancreatitis in dogs is based on the integration of serum canine-specific pancreatic lipase (cPLI) concentration, clinical presentation, and diagnostic imaging findings. However, markers of systemic inflammation and antiprotease activity have not been extensively investigated in the characterization and prognostication of pancreatitis in dogs. Serum concentrations of alpha₁-proteinase inhibitor (α₁PI; as a marker of systemic antiprotease response) and calprotectin and S100A12 (as markers of systemic inflammation) were measured in serum samples from 35 Miniature Schnauzers diagnosed with pancreatitis (serum cPLI concentration >400 μg/L, clinical signs, abdominal imaging findings). These markers were evaluated for possible associations with patient characteristics, clinical presentation, risk factors for pancreatitis, and outcome. The study showed that biomarkers of systemic inflammation and antiprotease activity are commonly increased in Miniature Schnauzers with pancreatitis. Whereas serum calprotectin and S100A12 concentrations were found to have limited utility in differentiating pancreatitis presentations, serum α₁PI concentrations and potentially also the serum calprotectin-to-S100A12 ratio might be non-invasive surrogate markers of disease severity in dogs with pancreatitis.

Serial measurement of cardiac troponin I in hospitalised dogs with canine parvoviral enteritis: Association with outcome and canine pancreas-specific lipase concentration

The aim of this study was to serially evaluate serum cardiac troponin I (cTnI) concentrations in dogs with parvoviral enteritis (CPVE), and investigate the association with outcome and serum pancreas-specific lipase (Spec cPL) concentrations. Dogs with CPVE that were hospitalised for at least 5 days were included. cTnI and Spec cPL concentrations were measured on days 1, 3 and 5 of hospitalisation. Twenty-nine dogs (20 survivors, 9 non-survivors) were included. Spec cPL was indicative of pancreatitis (>400 μg/L) on at least one day in 10/29 (34.5%) dogs. Serum median (range) cTnI concentration was higher (P = 0.021) in non-survivors on day 5 [0.032 (0.001-0.395) ng/mL] compared to day 1 [0.012 (0.003-0.196) ng/mL]. Non-survivors had higher (P = 0.014) cTnI concentrations on day 5 [0.032 (0.001-0.395) ng/mL] compared to survivors [0.001 (0.001-0.042) ng/mL], but not at admission or on day 3 (P > 0.05). Serum cTnI concentrations were not significantly different (P = 0.465) between the three Spec cPL groups [group 1 (Spec cPL ≤ 200 μg/L): 0.007 (0.001-0.527) ng/mL; group 2 (Spec cPL: 201-399 μg/L): 0.0045 (0.001-0.196) ng/mL; group 3 (Spec cPL ≥ 400 μg/L): 0.011 (0.001-0.278) ng/mL]. cTnI and Spec cPL concentrations were not significantly correlated (rho = -0.043, P = 0.703). Serial measurement of cTnI had prognostic value in the examined cohort. However, cTnI was not correlated with spec cPL.

Long-term nutritional management of an obese German Spitz with paroxysmal dyskinesia, calcium oxalate urolithiasis, and suspected pancreatitis—A case report

Background

To our knowledge, this is the first description of long-term nutritional management in a dog with paroxysmal dyskinesia.

Case summary

An obese 9-year-old, male entire, German Spitz was presented for dietary management after being diagnosed with calcium oxalate urolithiasis and suspected pancreatitis. Since he was seven years old, the dog has had a history of neurological signs, which were thought to be epileptic seizures. He was treated with phenobarbital and potassium bromide and was clinically controlled. For his nutritional advice, aiming to minimize one of the most important risk factors for the diseases, a weight loss program was started and successfully executed. However, 10 months later, the dog restarted presenting neurological episodes at a high frequency (3x/week). Based on videos and the characteristics of the neurological signs, the dog was diagnosed with paroxysmal dyskinesia. To investigate the role of gluten intake on this patient's neurological signs, a dietary trial with a commercial hypoallergenic diet (gluten-free; hydrolyzed protein) was followed. During the 3 months of the dietary trial, four neurologic episodes related to food indiscretion occurred. Upon the decrease in neurological episodes, the anti-seizure drugs were slowly discontinued. During this period, the dog presented only two neurologic episodes that were related to the days that the anti-seizure drugs were decreased. For 4 months the dog remained episode-free. However, a change in the dog's diet to another gluten-free diet (higher fat) led the dog to vomit and experience another neurologic episode. Once the dog was back to the previous gluten-free diet, it clinically improved, and no other clinical signs were reported by the client during the next 5 months.

Conclusion

Although a relationship between gluten and paroxysmal dyskinesia cannot be confirmed, the dog's improvement after the nutritional management and the removal of the anti-seizure therapy is supportive of dietary association.

Evaluation of Clinicopathological Data, the Specific Feline Pancreatic Lipase Assay, and Abdominal Ultrasound as Severity Determinants in Cats with Pancreatitis

Limited data exist to predict the severity of pancreatitis in cats. In this retrospective case series, we reviewed the medical records of 45 cats with SP from June 2014 to June 2019. Case definition was based on an internist’s review of clinopathologic data, Spec fPL concentration, and AUS findings. Information extracted from the medical records included signalment, history, physical examination findings, selected clinicopathological data (total bilirubin, glucose, ALP, ALT, and total calcium), Spec fPL concentration, AUS images/clips, length of hospitalization, and survival data. Hazard ratios were used to evaluate the association between clinicopathological data, the Spec fPL assay, AUS findings, and the length of hospitalization. Clinicopathological abnormalities, the Spec fPL, and AUS abnormalities were not statistically associated with the length of hospitalization. Despite a lack of statistical significance, the hazard ratios suggest the potential that an elevated total bilirubin (hazard ratio (HR): 1.19), hypocalcemia (HR: 1.49), and an elevated Spec fPL concentration (HR: 1.54) could be associated with prolonged hospitalization, although additional studies would be needed to verify this. Additionally, hazard ratios suggest that AUS evidence of concurrent gallbladder (HR: 1.61) and gastric abnormalities (HR: 1.36) could be associated with prolonged hospitalization.

Partial validation of the Vcheck canine pancreatic lipase assay

Measurement of canine pancreatic lipase immunoreactivity (cPLI) is used for diagnosing pancreatitis in dogs. Because pancreatitis can be a life-threatening disease with severe complications, an in-house cPLI test would be valuable to obtain rapid test results. The aim of this study was to evaluate a point-of-care cPLI test, Vcheck cPL. Precision, determined according to EP15, and linearity under dilution were determined and judged against preset quality goals. Results from the Vcheck cPL were compared with a previously validated cPLI ELISA, Spec cPL. In a retrospective study, cPLI results from dogs with and without acute pancreatitis, as determined by pancreatic ultrasound examination, were investigated to assess the performance of the assay in a clinical setting. Statistical analysis included the Mann-Whitney test, Chi-square test, and Passing-Bablok regression analysis with a significance level of 0.05. Precision of the assay was acceptable, with intra-, inter-, and total coefficients of variation (CV%) less than 12.1%, 6.4%, and 12.1%, respectively. Results from the linearity study indicated that the method was acceptably linear at lower concentrations but not in the high-concentration range. The method comparison study revealed that Vcheck generally measured higher concentrations compared with Spec cPL, and that the methods should not be used interchangeably. Dogs with acute pancreatitis had significantly higher cPLI concentrations compared with dogs without pancreatitis (P < 0.01), but there was a marked overlap in cPL concentrations between the two groups.

Evaluation of serum miR-216a and miR-375 as biomarkers in dogs with acute pancreatitis

BACKGROUND

Serum microRNAs have emerged as biomarkers of various diseases. Overexpression of serum miR-216a and miR-375 occurs in dogs with experimentally induced acute pancreatitis (AP).

OBJECTIVES

To identify the possibility of using serum miR-216a and miR-375 as biomarkers for the diagnosis and evaluation of treatment response in dogs with naturally occurring AP.

ANIMALS

Twenty-one dogs with AP and 20 healthy dogs.

METHODS

Cross-sectional study. The relative expression of serum hsa-miR-216a-5p, cfa-miR-216a, and cfa-miR-375 were analyzed using reverse transcription and real-time PCR.

RESULTS

A significant difference in the serum expression of cfa-miR-375 was found between dogs with AP (median [interquartile range] 3.59 [1.55-24.52]-fold) and healthy dogs (0.81 [0.54-2.21]-fold, P < .001), and no significant differences were observed in hsa-miR-216a-5p and cfa-miR-216a (P > .05). The area under the receiver operating characteristic curve of serum cfa-miR-375 for differentiating between AP dogs and healthy dogs was 0.84 (95% confidence interval [CI]: 0.71-0.96). The expressions of hsa-miR-216a-5p and cfa-miR-375 were positively correlated with the concentrations of serum C-reactive protein (r_s  = .46, r_s  = .48, respectively), but not with the serum specific canine pancreatic lipase. The expression of cfa-miR-375 was significantly less after treatment in dogs with AP (P = .02).

CONCLUSIONS AND CLINICAL IMPORTANCE

Serum cfa-miR-375 could be a potential biomarker for the diagnosis and evaluation of treatment response of AP in dogs. In addition, miR-216a and miR-375 could be associated with inflammatory processes in dogs with AP.

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.

Contrast-enhanced ultrasound features of focal pancreatic lesions in cats

A large overlap in the ultrasound (US) features of focal pancreatic lesions (FPLs) in cats is reported. Furthermore, only a small number of studies describing the contrast-enhanced ultrasound (CEUS) features of FPLs in cats have been conducted today. The aim of this study is to describe the B-mode US and CEUS features of FPLs in cats. Ninety-eight cats cytologically diagnosed with FPL were included. The lesions were classified as adenocarcinoma (n = 40), lymphoma (n = 11), nodular hyperplasia (n = 17), other benign lesion (OBL) (n = 20), cyst (n = 4) or other malignant lesion (OML) (n = 6). Several qualitative and quantitative B-mode and CEUS features were described in each case. OMLs and cysts were not included in the statistical analysis. A decision tree to classify the lesions based on their B-mode and CEUS features was developed. The overall accuracy of the cross-validation of the decision tree was 0.74 (95% CI: 0.63–0.83). The developed decision tree had a very high sensitivity and specificity for nodular hyperplasia (1 and 0.94, respectively) as well as good sensitivity and specificity for both adenocarcinomas (0.85 and 0.77, respectively) and OBLs also (0.70 and 0.93, respectively). The algorithm was unable to detect any specific feature for classifying lymphomas, and almost all the lymphomas were classified as adenocarcinomas. The combination between CEUS and B-mode US is very accurate in the classification of some FPLs, especially nodular hyperplasia and adenocarcinomas. Cytopathology and or histopathology is still a fundamental step FPL diagnostic workflow.

Serial Measurement of Serum Pancreatic Lipase Immunoreactivity, Feline Trypsin-like Immunoreactivity, and Cobalamin Concentrations in Kittens

Serum concentrations of feline pancreatic lipase immunoreactivity (fPLI), feline trypsin-like immunoreactivity (fTLI), and cobalamin are commonly used for the diagnostic investigation of cats with gastrointestinal signs. No information on these parameters in healthy cats less than 1 year of age exists. We aimed to evaluate serum concentrations of fPLI, fTLI, and cobalamin in healthy cats at different time-points during their first 12 months of life. Fourteen healthy 2-month-old kittens were included. Blood was collected at 2, 3, 4, 6, and 12 months of age, and serum concentrations of fPLI, fTLI, and cobalamin were measured. While there was a statistically significant difference in serum fPLI concentrations over time, there was no statistically significant difference between individual time-points. There was no significant difference in serum fTLI concentrations over time. Serum cobalamin concentrations were below the reference interval in 3/13 cats at 2 months of age and were significantly lower by 3 months, when 13/14 had hypocobalaminemia. By 12 months, serum cobalamin had significantly increased, yet 4/12 cats still had hypocobalaminemia. Serum fPLI and fTLI concentrations did not show any statistically or clinically significant differences in young kittens. In contrast, serum cobalamin concentrations were commonly below the reference interval in kittens. Serum fPLI and fTLI concentrations are not practically affected by age in kittens as young as 2 months of age and could be used for the investigation of pancreatic diseases.

Feline Comorbidities: Clinical perspective on diabetes mellitus and pancreatitis

PRACTICAL RELEVANCE

Diabetes mellitus (DM) is one of the most common feline endocrine disorders. It has been shown by several studies that DM in cats frequently coexists with pancreatitis.

CLINICAL CHALLENGES

It has not been definitively established what the exact pathogenetic association between DM and pancreatitis is in the cat. However, the association between these two conditions is most likely bidirectional, with DM predisposing cats to pancreatitis and vice versa. Diagnosis of pancreatitis in cats with DM is crucial because concurrent pancreatitis commonly leads to difficulties in the management of DM. When pancreatitis is associated with diabetic ketoacidosis (DKA), therapeutic management is even more challenging.

AIMS

This review focuses on the concurrent presence of DM or DKA and pancreatitis in cats, mainly focusing on their clinical management.

EVIDENCE BASE

Information provided in this review is based on feline-specific clinical research when available. In addition, comparative and human research, as well as clinical experience, has been used to enrich knowledge in areas where feline-specific research is not yet available.

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.

New insights into the etiology, risk factors, and pathogenesis of pancreatitis in dogs: Potential impacts on clinical practice

While most cases of pancreatitis in dogs are thought to be idiopathic, potential risk factors are identified. In this article we provide a state‐of‐the‐art overview of suspected risk factors for pancreatitis in dogs, allowing for improved awareness and detection of potential dog‐specific risk factors, which might guide the development of disease prevention strategies. Additionally, we review important advances in our understanding of the pathophysiology of pancreatitis and potential areas for therapeutic manipulation based thereof. The outcome of pathophysiologic mechanisms and the development of clinical disease is dependent on the balance between stressors and protective mechanisms, which can be evaluated using the critical threshold theory.

Long-term outcome of dogs recovering from acute kidney injury: 132 cases

Background

Information regarding long‐term outcome of dogs recovering from acute kidney injury (AKI) is limited.

Objectives

Determine the long‐term outcome of dogs recovering from AKI and identify predictors for serum creatinine concentration (sCr) normalization and long‐term outcome.

Animals

One hundred thirty‐two dogs with AKI that survived ≥30 days postdischarge.

Methods

Retrospective study. Search of medical records of dogs diagnosed with AKI that survived to discharge. Follow‐up data were retrieved from medical records and by telephone interviews with the owners or primary care veterinarians or both.

Results

Estimated median survival time (MST) was 1322 days (95% confidence interval [CI], 1147‐1626), and 76% of the dogs were alive at last contact. Normalization of sCr was documented in 55% of the dogs at discharge and in additional 20% during the follow‐up period. The proportion of dogs with sCr normalization decreased with increase in AKI grade (P = .02). Long‐term survival was not associated with sCr normalization (P = .63). Etiology was associated with the long‐term outcome (P = .004).

Conclusion and Clinical Importance

Long‐term survival of dogs with AKI is longer than previously described. Normalization of sCr in 99 dogs (75%) occurred, either at discharge or within the follow‐up period. Normalization of sCr was not associated with long‐term survival. Estimated MST of dogs with sCr normalization was not different compared with dogs that developed azotemic chronic kidney disease (CKD), presumably because of slow CKD progression rate. Etiology is an important factor determining sCr normalization and long‐term survival, emphasizing the importance of the reversibility of renal injury rather than its severity.

Gastrointestinal foreign body obstruction is not associated with abnormal point-of-care pancreas-specific lipase test results in dogs

OBJECTIVE

To determine the proportion of abnormal results for a point-of-care pancreas-specific lipase assay screening test in dogs lacking clinical evidence of acute pancreatitis with and without gastrointestinal foreign body obstruction (GIFBO).

ANIMALS

50 client-owned dogs with acute abdomen syndrome between April 2019 and January 2021.

PROCEDURES

In this prospective observational cohort study, dogs were enrolled into a control non-GIFBO group (n = 25) or GIFBO group (25) on the basis of clinical diagnostics performed at presentation. Dogs with evidence of pancreatitis were excluded. Data collected included signalment, body weight, clinical signs, hematologic test results, abdominal imaging findings, and intraoperative findings. SNAP canine pancreatic lipase (cPL) tests were performed for all dogs within 24 hours of presentation and prior to any surgical procedure. Results were analyzed across all dogs for any clinical associations.

RESULTS

The proportions of abnormal SNAP cPL test results in the GIFBO and non-GIFBO groups were 12% (3/25) and 16% (4/25), respectively, with no significant difference. The only differences between groups were that GIFBO canines were more likely to be male (P = 0.02) and had a slightly longer duration of clinical signs at presentation (P = 0.01). Abnormal SNAP cPL test results were associated with increasing age (P = 0.01).

CLINICAL RELEVANCE

SNAP cPL test results are mostly reliable but can still be abnormal in a small percentage of dogs with GIFBO. Abnormal results in dogs without pancreatitis occurred more frequently in older dogs of the present study. Abdominal imaging is advised for dogs with abnormal SNAP cPL test results.

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.

Accuracy of 1,2-o-Dilauryl-rac-glycero-3-glutaric Acid-(6'-methylresorufin) Ester (DGGR)-Lipase to Predict Canine Pancreas-Specific Lipase (cPL) and Diagnostic Accuracy of Both Tests for Canine Acute Pancreatitis

Different lipase assays have variable reported diagnostic accuracies for acute pancreatitis (AP) in dogs. The aims of this retrospective study were to evaluate optimal cutoffs for 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester (DGGR)-lipase to predict diagnostic cutoffs of canine pancreas-specific lipase (cPL; IDEXX). DGGR-lipase activity and cPL from the same blood draw in 301 dogs with a variety of diseases were compared using Spearman’s rank correlation, Cohen’s kappa agreement, and receiver operating characteristic (ROC) curves. Activity of DGGR-lipase (10−15,616 U/L) and cPL concentrations (8.1−≥2000 µg/L) were highly correlated (rs = 0.91). Areas under the ROC curves (AUCs) to predict cPL >200 and ≥400 µg/L with DGGR-lipase were 0.97 and 0.99, with optimal cutoffs of 143 U/L (sensitivity (Se) 91.7%; specificity (Sp) 95.3%) and 205 U/L (Se 97.5%; Sp 96.4%), and Cohen’s kappa agreements of 0.87 and 0.92, respectively. AUCs for a clinical diagnosis of AP, assigned to 87/301 dogs, with DGGR-lipase (0.75) and cPL (0.76) did not differ significantly (p = 0.48); optimal cutoffs were 161 U/L for DGGR (Se 67%; Sp 81%) and 235 µg/L for cPL (Se 68%; Sp 84%). To conclude, DGGR-lipase is a highly accurate predictor of cPL with a comparable performance when used to diagnose AP in dogs.

Seasonal differences in the intensity of acute phase response in dogs infected with Babesia canis

The highest number of acute Babesia canis cases in dogs is recorded over the February-May (Feb-May) period, which also represents the optimal climate conditions for tick activity in Belgrade, Serbia. A possibility that the acute phase response is more intense in dogs developing the disease in the Feb-May period compared with the response in other time periods of the year was tested. A total of 63 client-owned dogs with acute B. canis infection were enrolled and the routine hematology and biochemistry parameters-serum amyloid A (SAA), IgG against B. canis, level of parasitemia, ceruloplasmin (CER), paraoxonase-1 (PON-1), and fibrinogen-were measured. Acute phase indexes (API) were calculated as (SAA×CER)/(Iron×PON-1) and (SAA×CER)/(Albumin×Iron). Statistics included Kruskal-Wallis test and logistic regression analysis. The results showed that in the Feb-May period, the following parameters were lower: creatinine, albumin, iron, and level of parasitemia. Furthermore, increased API values were more probable in the Feb-May than in the other periods. Together, higher acute phase response intensity and presumptive hemodilution in the Feb-May period indicate a more acute course of B. canis infection than in other time periods of the year.

Accuracy of acute-phase proteins in identifying lethargic and anorectic cats with increased serum feline pancreatic lipase immunoreactivity

The mainstay of laboratory diagnostics of feline pancreatitis (FP) is measuring serum feline pancreatic lipase immunoreactivity (fPLI). Thus far, several studies have investigated the relationship between acute-phase proteins (APPs) and the presence and severity of FP. Although changes in serum amyloid A (SAA) concentration have been linked with FP, its diagnostic accuracy remains unknown. We aimed to determine the accuracy of selected APPs in identifying cats with a high risk of FP based on increased fPLI. Serum fPLI was measured in cats (n = 52) that were presented to veterinary clinics with signs of lethargy and anorexia. The cats were divided into two groups (fPLI ≤3.5 μg/L; n = 27 and fPLI >3.5 μg/L, n = 25), corresponding to low and high risks of FP. Serum albumin, globulin, haptoglobin (Hp), and SAA concentrations, as well as the albumin-to-globulin ratio (A/G) and SAA-to-albumin (SAA/A) ratios, were determined and compared between groups. The accuracy of these measurements was examined using a multivariable logistic regression model and receiver operator characteristic (ROC) curve analysis. SAA concentrations and SAA/A ratios were significantly (P = .026 and P = .022) higher in cats with increased fPLI, with the area under ROC curve (AUROC) of 68.1% (CI 95%: 53.4%, 82.9%) and 68.6% (CI 95%: 54.0%, 83.2%), respectively. The logistic regression model combining SAA and A/G had AUROC of 75.2% (CI 95%: 62.0%, 88.4%) for identifying cats with increased fPLI. SAA as a sole analyte or combined with A/G had low to moderate accuracy in identifying anorexic, lethargic cats with increased fPLI. Serum albumin, globulin, and Hp concentrations had no discriminatory potential in these cats.

Acute kidney injury in dogs: Etiology, clinical and clinicopathologic findings, prognostic markers, and outcome

BACKGROUND

Acute kidney injury (AKI) is a common, potentially fatal condition.

OBJECTIVES

To characterize the etiologies, clinical and clinicopathologic findings, hospitalization period, and outcome of dogs with AKI and to identify markers of negative prognosis.

ANIMALS

Two hundred forty-nine client-own dogs diagnosed with AKI and hospitalized at a veterinary teaching hospital.

METHODS

Retrospective study. Search of medical records for dogs with AKI.

RESULTS

Common clinical signs included lethargy (225/249, 90%), anorexia (206/249, 83%), and vomiting (168/249, 68%). Etiologies included ischemic/inflammatory (144/249, 58%), infectious (19/249, 8%), nephrotoxicosis (14/249, 6%), or other (13/249, 5%). Hospital-acquired AKI was diagnosed in 9% (23/249) of the dogs. Median presentation and peak serum creatinine (sCr) concentrations were 4 mg/dL (range, 1.1-37.9) and 4.6 mg/dL (range, 1.1-43.1), respectively. Dogs were classified to AKI grades as follows: Grade I, 6 (2%), Grade II, 38 (15%), Grade III, 89 (36%), Grade IV, 77 (31%), and Grade V, 39 (16%). One hundred and sixty-four (66%) dogs survived. There was a positive association between death and AKI grade (P = .009). The case fatality rate was higher among dogs with anuria compared with dogs without anuria (50% vs 28%, respectively; odds ratio [95% confidence interval]: 2.5 [1.39-4.6]; P = .002). Forty-seven (18.8%) dogs underwent hemodialysis, of which 60% survived.

CONCLUSION AND CLINICAL IMPORTANCE

Two-thirds of dogs with AKI survived. Hospital-acquired AKI was common. The severity of AKI, as reflected by presence of anuria, AKI grade, and other body organs involvement, was associated with the outcome.

Correlation between metabolomic profile constituents and feline pancreatic lipase immunoreactivity

Background

Feline pancreatic lipase immunoreactivity (fPLI) is commonly used to diagnose pancreatitis in cats (FP). Untargeted metabolomics has been extensively applied in human and veterinary medicine, but no metabolomic studies regarding FP have been conducted.

Objectives

To identify metabolites significantly associated with increased fPLI.

Animals

Forty‐nine client‐owned cats: 11 clinically healthy and 38 with various clinical conditions.

Methods

Analytical cross‐sectional study with convenience sampling. A panel of 630 metabolites belonging to 26 biochemical classes was quantified in plasma using a commercial metabolomic assay. The correlation between plasma metabolite concentrations and serum fPLI was evaluated using Spearman's rank correlation coefficient (R_s) with Bonferroni correction. Multivariable analysis then was performed to control for glomerular filtration rate, liver damage, and blood glucose concentration. The accuracy of selected metabolites in discriminating between cats with normal (≤3.5 μg/L) and increased (>5.3 μg/L) fPLI was estimated using the area under the receiver operating characteristic curve (AUROC).

Results

Four hundred and seven of 630 metabolites (64.6%) were quantified in all cats. When controlled for potential confounders only 3 sphingolipids were significantly positively correlated with fPLI: 2 cerebrosides: HexCer(d18:1/24:0); (R_s = .56), and HexCer(d18:1/24:1); (R_s = .58) and 1 sphingomyelin: SM C18:0 (R_s = .55). Their AUROCs in identifying cats with increased fPLI were 82% (95% confidence interval [CI 95%], 70%‐94%), 84% (CI 95%, 72%‐96%), and 78% (CI 95%, 65%‐92%), respectively.

Conclusions and Clinical Importance

Selected sphingolipids are moderately positively correlated with fPLI and appear to have fair to moderate diagnostic accuracy in discriminating between cats with normal and increased fPLI.

Application of a complete blood count to screening lethargic and anorectic cats for pancreatitis

Background

Feline pancreatitis (FP) is an important health problem of cats. Its diagnostics is based on the combination of quantification of serum pancreatic lipase immunoreactivity (fPLI) and abdominal ultrasonography (AUS). These modalities allow for establishing highly specific diagnosis, however they are relatively expensive and time-consuming. On the other hand, a screening test of high sensitivity which would allow to rule out FP on the first visit without a considerable increase of costs would be clinically useful. To evaluate accuracy of nonspecific inflammatory biomarkers based on complete blood count (CBC) in diagnosing FP 73 client-owned cats with signs of lethargy and reduced appetite lasting for at least 2 days before presentation were enrolled in the cross-sectional study. They were examined with fPLI assay and AUS and classified as cats with very low risk of FP when fPLI ≤3.5 μg/L and AUS negative for FP, or as cats with increased risk of FP in the case of any other combination of results. Then, 7 various CBC measurements were measured in each cat and linked to the risk of FP using the multivariable logistic regression.

Results

Five CBC measurements turned out to be significantly associated with the risk of FP – total leukocyte count (WBC; crude odds ratio(OR_crude) = 12.2; CI 95%: 1.52, 98.5), total neutrophil count (OR_crude = 5.84; CI 95%: 1.22, 27.9), band neutrophil count (BNC; OR_crude = 6.67; CI 95%: 1.98, 22.4), neutrophil-to-lymphocyte ratio (OR_crude = 3.68; CI 95%: 1.25, 10.9), and eosinophil count (EC; OR_crude = 0.34; CI 95%: 0.12, 0.96). The model based on WBC, BNC, and EC proved to have at least fair diagnostic potential (area under ROC curve 82.7%; CI 95%: 72.8%, 92.5%). When WBC <  18 G/L, BNC <  0.27 G/L, and EC >  0.3 G/L was considered as a negative result, and any other combination as the positive result, the CBC model had high sensitivity (91.8%; CI 95%: 80.8%, 96.8%) at a relatively low specificity (58.3%; CI 95%: 38.8%, 75.5%).

Conclusion

The combination of three CBC measurements is an immediately available and fairly accurate screening method for identification of lethargic and anorectic cats with increased risk of FP.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12917-021-03098-z.

Analysis of Pain and Analgesia Protocols in Acute Cerulein-Induced Pancreatitis in Male C57BL/6 Mice

Pancreatitis is known to be painful in humans and companion animals. However, the extent of pain in experimental mouse models of acute pancreatitis is unknown. Consequently, the severity classification of acute pancreatitis in mice is controversially discussed and standardized pain management is missing. In this study, we investigated acute Cerulein-induced pancreatitis with pain-specific and well-being orientated parameters to detect its impact on mice. Male C57BL/6J male mice were injected with Cerulein; animals that received saline injections served as control group. The animals were observed for weight change and water intake. To assess pain, behaviors like stretch-and-press and reduced rearing, the Mouse Grimace Scale, and von Frey hypersensitivity were assessed. Fecal corticosterone metabolites and burrowing behavior were assessed to detect changes in the animal’s well-being. Pancreatitis severity was evaluated with amylase and lipase in the blood and pancreas histology. To investigate whether different analgesics can alleviate signs of pain, and if they influence pancreas inflammation, animals received Buprenorphine, Paracetamol in combination with Tramadol, or Metamizole in the drinking water. The calculated intake of these analgesics via drinking reached values stated to be efficient for pain alleviation. While pancreatitis did not seem to be painful, we detected acute pain from Cerulein injections that could not be alleviated by analgesics. The number of inflammatory cells in the pancreas did not differ with the analgesic administered. In conclusion: (1) Cerulein injections appear to be acutely painful but pain could not be alleviated by the tested analgesics, (2) acute pancreatitis induced by our protocol did not induce obvious signs of pain, (3) analgesic substances had no detectable influence on inflammation. Nevertheless, protocols inducing more severe or even chronic pancreatitis might evoke more pain and analgesic treatment might become imperative. Considering our results, we recommend the use of Buprenorphine via drinking water in these protocols. Further studies to search for efficient analgesics that can alleviate the acute pain induced by Cerulein injections are needed.

Advances in the diagnosis of acute pancreatitis in dogs

In the last 20 years, the diagnosis of pancreatitis has become more frequent as a result of improved diagnostic modalities such as abdominal ultrasound examination, advanced imaging, and immunoassays for the measurement of pancreatic lipase. Our aim is to provide a state‐of‐the‐art overview of the clinical diagnosis of acute pancreatitis (AP) in dogs with a particular focus on pancreatic lipase assay validation and clinical performance, in addition to advanced imaging modalities. We also discuss the potential indications for cytology and histopathology in dogs with suspected AP.

Serum feline pancreatic lipase immunoreactivity and trypsin-like immunoreactivity concentrations in cats with experimentally induced chronic kidney disease

Background

Serum feline pancreatic lipase immunoreactivity (fPLI) and trypsin‐like immunoreactivity (fTLI) concentrations are commonly used in cats for the evaluation of pancreatic disease. The effect of kidney disease on these tests in cats are unknown.

Objective

To investigate the effect of experimentally induced chronic kidney disease (CKD) on serum fPLI and fTLI concentrations.

Animals

Surplus serum samples from 20 cats with CKD experimentally induced for an unrelated project and a group of healthy control cats.

Methods

Serum fTLI and fPLI concentrations were compared between groups.

Results

Mean (±SD) serum fTLI concentrations in 20 cats with CKD (117.8 ± 63.6 μg/L) were significantly higher than those in healthy cats (n = 32; 46.9 ± 17.5 μg/L; P < .0001). Serum fTLI concentrations in cats with CKD were above the upper limit of the reference interval in 13 of 20 cats (65%). Serum fPLI concentrations were not significantly different between cats with induced CKD (n = 18; 8.6 μg/L; range, 5.4‐9.9 μg/L) and healthy cats (n = 41; 7.4 μg/L; range, 5.0‐15.2 μg/L; P = .12). All cats with experimentally induced CKD had serum fPLI concentrations within the reference interval.

Conclusions and Clinical Importance

Decreased renal function has a clinically relevant impact on serum fTLI concentrations and potentially could interfere with a diagnosis of exocrine pancreatic insufficiency (EPI). Serum fPLI concentration was not affected by experimentally induced CKD and thus serum fPLI may be used for the diagnosis of pancreatitis in cats with kidney disease. Additional studies are needed to verify these results in cats with naturally occurring CKD.

Prospective evaluation of 5 urinary biomarkers as predictors of acute kidney injury in nonazotemic, hospitalized dogs

BACKGROUND

Early recognition of acute kidney injury (AKI) is hindered by current definitions and use of traditional, insensitive markers.

HYPOTHESIS/OBJECTIVES

Urinary (u) activity of γ-glutamyl transpeptidase (GGT) and alkaline phosphatase (ALP), and concentrations of heat-shock protein 70 (HSP70) and interleukins (ILs) -6 and -18, are predictive biomarkers for AKI and survival.

ANIMALS

Nonazotemic, hospitalized dogs (n = 118) and healthy controls (n = 20).

METHODS

A prospective observational study. Nonazotemic dogs at risk of AKI were recruited and their urinary biomarker concentrations were measured at presentation. Serum creatinine (sCr) and symmetric dimethylarginine (sSDMA) were measured daily until discharge/death.

RESULTS

The overall case fatality rate was 18.6%. Fifteen dogs (12.7%) developed AKI, which was associated with death (relative risk, 3.2; 95% confidence interval [CI], 1.57-6.55). All 5 urinary biomarkers were significantly higher in hospitalized dogs compared to controls, with minimal overlap. uHSP70/uCr, uGGT/uCr, and uIL-6/uCr at presentation were higher in dogs which later developed AKI. Areas under the receiver operator characteristic curve (AUROC) (95% CI) for the 3 biomarkers as predictors of AKI were 0.67 (0.51-0.83), 0.68 (0.55-0.81), and 0.78 (0.65-0.91), respectively. When they were categorically classified as elevated/normal, each additional elevated biomarker increased the odds for AKI (OR, 2.83; 95% CI, 1.23-6.52, P = .01). Agreement between sCr and sSDMA was poor (Cohen's kappa = .071). The AUROC of SDMA at presentation for AKI prediction was 0.73 (0.51-0.95).

CONCLUSIONS AND CLINICAL IMPORTANCE

Kidney injury was common, irrespective of subsequent worsening of azotemia or death. The predictive value of individual urinary biomarkers was reduced by moderate sensitivities and specificities. SDMA showed moderate discriminatory utility for AKI prediction, and often displayed discordant results with sCr.

BIOMARKERS OF GASTROINTESTINAL DISEASE IN CHEETAHS (ACINONYX JUBATUS)

Gastrointestinal disease is a common clinical problem in captive cheetahs (Acinonyx jubatus). It is reported that gastritis affects the vast majority of the captive population of cheetahs. Pancreatitis and acute and chronic enteritis have also been reported. These issues pose significant long-term health and welfare implications for cheetahs. Cobalamin, folate, methylmalonic acid (MMA), gastrin, feline pancreatic-specific lipase immunoreactivity (fPLI), and feline trypsin-like immunoreactivity (fTLI) immunoassays are important biomarkers of gastrointestinal disease in domestic cats. The goal of this study was to determine if these immunoassays validated in domestic cats could be used clinically in cheetahs, by establishing reference intervals (RI) for these biomarkers in cheetahs. A cohort of 40 clinically healthy cheetahs was selected from three zoological institutions on the basis of being free of clinical gastrointestinal disease and extra-gastrointestinal disease that could affect biomarkers, as well as having banked frozen serum. Cheetah biomarker RI, with domestic cat RI for comparison in parentheses, are as follows: cobalamin 470-618 pg/ml (290-1500 pg/ml), folate 2.2-15.7 ng/ml (9.7-21.6 ng/ml), MMA 365-450 nM/L (139-897 nM/L), fPLI 0.5-1.2 µg/L (0-4 µg/L), and gastrin 30-50 pg/ml (<10^-39.5 pg/ml). This study shows that RI for gastrointestinal biomarkers can be notably different, even between species that are as closely related as the domestic cat and the cheetah. Additionally, it was found that the fTLI assay does not cross-immunoreact with cheetahs. In conclusion, this study emphasizes the importance of developing species-specific RI for biomarker assays and using caution when extrapolating RI from other species.

Cyclosporine Treatment in Cats with Presumed Chronic Pancreatitis-A Retrospective Study

Simple Summary

Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine, an immunosuppressive drug, has been suggested as an alternative treatment when other drugs that suppress inflammation are ineffective or unsuitable. However, no published studies have investigated its efficacy in cats with CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine as a treatment for pancreatitis in cats with presumed CP. All cats had a history and clinical signs suggestive of CP and blood samples showed abnormally high concentrations of feline pancreas-specific lipase (Spec fPL) on at least two occasions. This is common in CP. All cats were treated with cyclosporine for at least three weeks. Nineteen cats, aged 6.9–17.5 years, were included. Daily treatment with cyclosporine resulted in an improvement of serum Spec fPL concentrations which indicates that the pancreatic inflammation likely had improved. The study has several limitations, including different treatment durations and doses, lack of biopsies to confirm CP and the treatment effect was not compared with an untreated control group. Despite the limitations, our results suggest that cyclosporine treatment decreases serum Spec fPL concentrations and may be effective in the management of feline chronic pancreatitis.

Abstract

Chronic pancreatitis (CP) is a common disease in middle-aged to older cats. Cyclosporine has been suggested as an alternative treatment when other immunosuppressive treatments are insufficient or contraindicated. However, no published studies have investigated its efficacy on feline CP. The aim of this retrospective study was to evaluate the efficacy of cyclosporine on supranormal serum feline pancreas-specific lipase (Spec fPL) concentrations in cats with presumed CP. Inclusion criteria were history and clinical signs suggestive of CP, serum Spec fPL concentrations above 5.3 μg/L (reference range 0–3.5 μg/L, equivocal range 3.6–5.3 μg/L) on at least two occasions and treatment with cyclosporine for at least three weeks. Serum Spec fPL was analyzed at Idexx Laboratories, Kornwestheim, Germany. Nineteen cats, aged 6.9–17.5 years (median 11.6), were included. No pancreatic biopsies were available. Median (range) serum Spec fPL concentration was 14.2 μg/L (6.1–43.3) at baseline and 6.7 μg/L (0.9–23.6) at follow-up. Cyclosporine treatment (5.0–7.9 mg/kg orally SID) was associated with a significant reduction in serum Spec fPL concentrations (p < 0.001) at follow-up after 23–206 days (median 35). Body weight decreased significantly between inclusion and follow-up (p = 0.013). Significant improvement of clinical signs could not be measured (p = 0.781). This study has several limitations, including unstandardized treatment length and dose, no control group and lack of pancreatic biopsies. Despite the limitations, our results suggest that cyclosporine treatment reduces supranormal serum Spec fPL concentrations in cats with presumed CP.

Evaluation of diagnostic and prognostic usefulness of abdominal ultrasonography in dogs with clinical signs of acute pancreatitis

OBJECTIVE

To report abdominal ultrasonography (AUS) findings in dogs with clinical signs of acute pancreatitis (AP) during the first 2 days of hospitalization and to compare AUS findings with severity of disease and mortality rate.

ANIMALS

37 client-owned dogs with clinical signs of AP.

PROCEDURES

Dogs suspected of having AP with complete medical records, AUS examinations performed throughout the first 2 days of hospitalization, and available frozen surplus serum samples for quantitative measurement of canine pancreatic lipase (cPL) concentrations at hospital admission met the criteria for study inclusion. Dogs were grouped as AUS+ or AUS- on the basis of positive or negative findings for AP on AUS, respectively. Abdominal ultrasonography findings of AP were stratified (as mild, moderate, or severe) by use of an AUS severity index, and a canine acute pancreatitis severity score was calculated.

RESULTS

24 of 37 (64.8%) dogs had AUS findings of AP at hospital admission, whereas 10 had positive findings for AP on AUS within 2 days of hospitalization. Three (8%) dogs were AUS- but had serum cPL concentrations > 400 μg/L (ie, values considered diagnostic for AP). On the AUS severity index, 5 of 34 (14.7%) AUS+ dogs had mild findings, 18 (52.9%) AUS+ dogs had moderate findings, and 11 (32.4%) AUS+ dogs had severe findings. Severe findings were associated with a higher risk of death than mild and moderate findings. A significant association was found between canine acute pancreatitis severity scores and mortality rates.

CONCLUSIONS AND CLINICAL RELEVANCE

For dogs with clinical signs of AP, repeated AUS examinations during hospitalization should be performed, severe findings on the AUS severity index may indicate an increased risk of death, and serum cPL concentrations may increase earlier than findings on AUS of AP.

Evaluation of serum histone concentrations and their associations with hemostasis, markers of inflammation, and outcome in dogs with naturally occurring acute pancreatitis

OBJECTIVE

To compare serum concentrations of histones and inflammatory markers in dogs with acute pancreatitis and healthy control dogs, investigate associations of these variables with coagulation test results and survival (vs nonsurvival) to hospital discharge, and examine the prognostic utility of clinical findings and routine laboratory and coagulation tests in affected dogs.

ANIMALS

36 dogs.

PROCEDURES

Dogs with findings consistent with acute pancreatitis (n = 29) and healthy control dogs (7) were enrolled in a prospective, observational study. Serum concentrations of histones, interleukin (IL)-6, and tumor-necrosis factor-α were assessed for all dogs. Clinical (including ultrasonographic) findings, relevant history, routine laboratory and coagulation test results, and outcomes were recorded for dogs with pancreatitis. Variables were assessed to determine an association with outcome for affected dogs and hospitalization time for survivors; histone concentrations and markers of inflammation were compared among survivors, nonsurvivors, and controls. Correlation between quantitative variables was investigated.

RESULTS

Serum histone and IL-6 concentrations did not differentiate survivors (n = 23) from nonsurvivors (6); IL-6 concentrations in affected dogs were correlated with 1,2-o-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester lipase activity (r_S = 0.436) and hospitalization time (r_S = 0.528). Pancreatitis-associated peritoneal fluid, obtundation, and jaundice were more common, and serum bilirubin concentration, serum alanine aminotransferase and aspartate aminotransferase activities, and prothrombin and activated partial thromboplastin times were greater in nonsurvivors than in survivors. Thromboelastometric changes consistent with hypercoagulability were detected in survivors; hypocoagulability was detected in 2 nonsurvivors.

CONCLUSIONS AND CLINICAL RELEVANCE

Serum histone concentrations were not associated with presence of acute pancreatitis or outcome for affected dogs. Further research is needed to investigate the clinical and therapeutic implications of hypocoagulability, hepatocellular injury, and pancreatitis-associated peritoneal fluid in affected dogs.

Corticosteroid treatment for acute/acute-on-chronic experimental and naturally occurring pancreatitis in several species: a scoping review to inform possible use in dogs

Acute pancreatitis in dogs is a prevalent disease characterised by mild to severe inflammation. Treatment with anti-inflammatory corticosteroids has been widely debated but is not generally recommended in veterinary medicine. The objective of the present study was to present current evidence on the effect of corticosteroid treatment for acute/acute-on-chronic pancreatitis across species. These findings were then used to evaluate if and how corticosteroid treatment could influence disease outcome in canine acute/acute-on-chronic pancreatitis. A scoping review was performed by searching the Agricola, CAB Abstracts, MEDLINE and Embase databases to identify relevant articles published before June 24, 2021. The inclusion criteria were English language, original research published in a peer-reviewed journal, and investigation of corticosteroid treatment effects on acute/acute-on-chronic pancreatitis by the outcome parameters clinical score, circulating CRP level, hospitalisation duration, mortality and pancreas histopathology. Research on any species was considered. Studies were rated based on the level of evidence, and methodological quality was evaluated based on similarity between groups at baseline, risk of bias and study group size. The reporting method was based on the PRISMA extension for scoping reviews. One thousand nine hundred fifty-four studies were identified, and 31 met the inclusion criteria. Five were canine studies, with 4 investigating experimentally induced pancreatitis; 5 were human clinical studies; and 21 were rodent studies of experimentally induced pancreatitis. The level of evidence ranged between randomised controlled trials and case series, the estimated risk of bias ranged from low to high, and the sample sizes ranged from very small to moderate. Evidence indicates that adding corticosteroid to symptomatic treatment of acute/acute-on-chronic canine pancreatitis could have a positive influence on disease outcome. However, the analysed evidence was based on several species, including both naturally occurring and experimentally induced pancreatitis; thus, the authors suggest that large randomised controlled studies should be performed in dogs with spontaneously occurring acute/acute-on-chronic pancreatitis to further elucidate a potential benefit of corticosteroid treatment.

Retrospective study evaluation of DGGR lipase for diagnosis, agreement with pancreatic lipase and prognosis in dogs with suspected acute pancreatitis

OBJECTIVES

Activity of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6'-methylresorufin) ester (DGGR) lipase is considered to be more pancreas specific than traditional lipase assays. The aim of this study was to evaluate the diagnostic performance of DGGR lipase activity for suspected acute pancreatitis in dogs and to assess its prognostic usefulness.

METHODS

Retrospective study of case records for suspected acute pancreatitis based on clinician-stated diagnosis, point-of-care and quantitative canine pancreas-specific lipase (cPL) results and consistent ultrasonographic features. Diagnostic performance of DGGR lipase was assessed by receiver-operating characteristic curve analysis, agreement by Cohen's kappa (κ) and prognostic value by multiple regression analysis.

RESULTS

Median DGGR lipase activity was significantly (P < 0.001) higher in dogs with suspected acute pancreatitis [93.7 (range, 11.0-2853.0) U/L (n = 158)] compared to those with no evidence of pancreatitis [range, 20.9 (6.7-89.0) U/L (n = 356)]. A DGGR lipase activity >42.15 U/L had the best combined diagnostic sensitivity (81.0%) and specificity (92.1%). Previously established cut-offs (>130 and >80 U/L) had sensitivities of 40.5 and 43.0%, and specificities of 100 and 99.7%, respectively. There was near perfect (κ = 0.821) and substantial (κ = 0.751) agreement between DGGR lipase activity >42.15 U/L and quantitative cPL concentrations ≥200 and ≥400 μg/L, respectively. DGGR lipase activity but not quantitative cPL concentration was statistically (P = 0.043, odds ratio = 0.999) predictive of discharge but clinical utility is questionable.

CLINICAL SIGNIFICANCE

Using DGGR lipase at the lower cut-off could provide an additional test for supporting a diagnosis of acute pancreatitis in dogs particularly if cPL results are not available. Larger studies are required to more fully assess its value in prognostication.

Serum trypsin-like immunoreactivity in dogs with diabetes mellitus

Background

Concurrent exocrine pancreatic dysfunction and decreased pancreatic organ size are common findings in various stages of human type 1 diabetes mellitus (DM). Exocrine pancreatic insufficiency (EPI) is incompletely described in diabetic dogs.

Objective

To compare canine trypsin‐like immunoreactivity (cTLI) of diabetic dogs with that of healthy controls. A secondary aim was to evaluate the correlation between duration of DM and cTLI.

Animals

Thirty client‐owned diabetic dogs and thirty client‐owned control dogs.

Methods

Cross‐sectional study. Diabetic and healthy control dogs were included if they had no clinical evidence of pancreatitis and if serum samples obtained after food was withheld were available. Serum cTLI was measured at a reference laboratory and compared between groups. Canine pancreatic lipase immunoreactivity (cPLI) was analyzed concurrently as an indicator of pancreatitis.

Results

The median cTLI concentration in all diabetic dogs (36.4 μg/L [range, 7.0‐288 μg/L]) did not differ from control dogs (28.7 μg/L [range, 12.8‐58.6 μg/L]) (P = .07; difference −7.8 μg/L [95% Confidence Interval (CI), −23.5 to 0.6 μg/L]). There was still no difference in cTLI between groups after exclusion of dogs with cPLI consistent with pancreatitis (n = 8 diabetic dogs). There was no correlation between cTLI and DM duration in all diabetic dogs (r = −0.07, [95% CI, −0.43 to 0.3], P = .7).

Conclusions and Clinical Importance

There was no evidence of EPI as evaluated using cTLI in this cohort of diabetic dogs, but concurrent increases in cPLI suggest cTLI might not be the optimal indicator of exocrine pancreatic dysfunction in dogs with DM.

Frequency of detection and load of amastigotes in the pancreas of Leishmania infantum-seropositive dogs: clinical signs and histological changes

BACKGROUND

Zoonotic visceral leishmaniasis is caused by the protozoan Leishmania infantum and is highly lethal in humans and dogs if left untreated. The frequency of this parasite and associated histological changes in the pancreas of dogs are poorly studied. Therefore, the objectives of this study were to evaluate the frequency of detection and load of amastigotes in the pancreas of L. infantum-seropositive dogs and to identify the clinical signs and histological changes associated with parasitism of this organ.

METHODS

One hundred forty-three dogs from an endemic area in Brazil that tested seropositive for L. infantum were studied. The dogs were clinically examined, killed, and necropsied between 2013 and 2014. One fragment of the pancreas was randomly collected for histopathology and immunohistochemistry, and spleen and bone marrow were collected for culture.

RESULTS

Leishmania amastigotes were detected in the pancreas of 22 dogs (15.4%) by immunohistochemistry, all exhibiting L. infantum parasitism in the spleen and/or bone marrow. Poor body condition and cachexia were only associated with infection of the pancreas with Leishmania spp. (p = 0.021) and were found in 40.9% of dogs with pancreatic infection. Anorexia, vomiting, and/or diarrhea were observed in 9.2% of dogs with pancreatitis. The median parasite load in the pancreas was 1.4 infected macrophages/mm². Pancreatic histological changes and their frequencies were: granulomatous pancreatitis (28.0%), lymphoplasmacytic pancreatitis (23.8%), acinar cell degeneration (6.3%), fibrosis (5.6%), hemorrhage (2.1%), eosinophilic pancreatitis (0.7%), suppurative pancreatitis (0.7%), and necrosis (0.7%).

CONCLUSIONS

The present results demonstrate that L. infantum is one of the etiological agents of chronic pancreatitis in dogs; however, the frequency of detection and parasite load are low in this organ. The lack of an association of poor body condition and cachexia with pancreatitis and the low frequency of clinical signs commonly associated with pancreatitis suggest that a significant portion of the organ is not affected by this parasite. On the other hand, the association of poor body condition and cachexia with concomitant infection of the pancreas, spleen, and/or bone marrow with this parasite suggests that these manifestations are the result of a more advanced stage of canine visceral leishmaniasis.

Evaluation of 1,2-O-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester (DGGR) and 1,2-diglyceride lipase assays in dogs with naturally occurring hypercortisolism

1,2-O-dilauryl-rac-glycero glutaric acid-(6'-methylresorufin) ester (DGGR) lipase activity has been proposed as a faster and less expensive test used in the diagnosis of acute pancreatitis (AP) compared to canine pancreatic lipase immunoreactivity (cPLI), which is considered the most sensitive and specific serum test available for dogs. Elevations in lipase activity have been observed in dogs with naturally occurring hypercortisolism (HC) and in those treated with exogenous steroids, which complicates the diagnosis of AP in dogs with HC. We compared lipase activity measured by DGGR and 1,2-diglyceride (1,2-DiG) assays in 22 dogs with HC, 22 with AP, and 22 healthy dogs. The dogs with HC had no clinical signs or ultrasonographic findings consistent with AP. DGGR lipase activity was elevated in 64% and 73% of the dogs with HC and AP, respectively, and in 18% of healthy dogs. 1,2-DiG lipase activity was high in 23% and 36% of the dogs with HC and AP, respectively, and in 5% of the healthy dogs. Both DGGR and 1,2-DiG lipase activities were significantly different between the healthy dogs and the other 2 groups, whereas no differences were detected between the dogs with HC and those with AP. Our results support a lack of specificity for both DGGR and 1,2-DiG lipase activity assays in aiding the diagnosis of AP in dogs with HC.