Agreement of Serum Spec cPL with the 1,2‐o‐Dilauryl‐Rac‐Glycero Glutaric Acid‐(6′‐methylresorufin) Ester (<scp>DGGR</scp>) Lipase Assay and with Pancreatic Ultrasonography in Dogs with Suspected Pancreatitis

BackgroundDiabetic ketoacidosis (DKA) is a relatively common endocrine disorder in dogs and is routinely associated with concurrent pancreatic injury.ObjectivesThe aims of this study were to determine the prevalence of pancreatic injury in dogs with DKA based on measurement of pancreatic lipase immunoreactivity in serum (PLI); compare demographic, clinicopathologic, and ultrasonographic findings in dogs with and without evidence of concurrent pancreatic injury; determine the impact of pancreatic injury on duration of hospitalization and short‐term outcome.AnimalsOne hundred and nineteen dogs with DKA with or without concurrent pancreatic injury.MethodsRetrospective study. Dogs with DKA were divided into three groups on the basis of PLI results: positive for pancreatic injury (PLI pos), negative for pancreatic injury (PLI neg), and not tested (PLI na). Demographics, clinicopathologic test results, findings on abdominal ultrasonography (AUS), duration of hospitalization, and short‐term outcome were compared between the three groups.ResultsBased on serum PLI activity, 45 dogs (73%) with DKA had evidence of concurrent pancreatic injury. Median total carbon dioxide was significantly lower in the PLI pos dogs compared to the PLI neg dogs. There was fair agreement (κ = 0.26) between serum PLI activity and AUS. Evidence of pancreatic injury was not associated with significantly longer periods of hospitalization (PLI pos median 6 days, range 4–7 days, PLI neg median 4 days, range 3–6 days) and did not influence short‐term outcome (PLI pos failure to survive to discharge 11/45, 24%, PLI neg failure to survive to discharge 2/17, 12%).Clinical ImportanceConcurrent pancreatic injury is common in dogs with DKA, but did not affect prognosis in this population of dogs.

Section: Discussionsupporting

confidence: 91%

Pancreatic Lipase Immunoreactivity in Serum of Dogs with Diabetic Ketoacidosis

Bolton

Cook

Steiner

et al. 2016

“…In this retrospective study, we evaluated the correlation between ultrasonographic evidence of pancreatitis, pancreatic lipase concentration, clinical severity indices, and a CDx of pancreatitis in 157 client‐owned dogs. The results of this study highlight a discrepancy between AUS and pancreatic lipase concentrations in the diagnosis of pancreatitis in dogs, similar to previously reported . This study also highlights a discrepancy between the ultrasonographic assessment of severity of pancreatitis and the validated clinical severity indices with only minor modifications.…”

Section: Discussionsupporting

confidence: 80%

Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis

Cridge

Sullivant

Wills

et al. 2020

Background A clinical diagnosis (CDx) of pancreatitis includes evaluation of clinical signs, abdominal ultrasound (AUS), and pancreatic lipase. However, practitioners are using AUS to diagnose pancreatitis and are using AUS severity to guide decisions. The validity of this is unknown. Objectives To determine whether (1) there is a correlation between AUS, specific canine pancreatic lipase (Spec cPL) assay, and CDx; (2) individual AUS abnormalities correlate more closely with CDx than others; (3) AUS severity mirrors clinical severity indices; (4) changes in AUS can be used as a marker for changes in Spec cPL or CDx; and (5) the sensitivity and specificity of AUS for pancreatitis. Animals One hundred fifty‐seven dogs. Methods In this retrospective case study, inclusion criteria were signs of gastrointestinal, pancreatic disease, or both, in addition to having a Spec cPL and AUS performed within 30 hours. Information extracted from the records included bloodwork, Spec cPL, AUS images/clips, and severity of ultrasonographic findings. Results AUS was weakly correlated with Spec cPL (rs = .0178, P = .03) and moderately correlated with CDx (rs = .379, P = <.001). Pancreatic size (rs = .285, P = <.001), echogenicity (rs = .365, P = <.001), and mesenteric echogenicity (rs = .343, P = <.001) were correlated with CDx. Change in AUS was not correlated with Spec cPL or CDx changes. When pancreatic enlargement, echogenicity, or altered mesenteric echogenicity were required for a diagnosis, the sensitivity and specificity were 89% (95% confidence interval [CI] 71.8, 97.7) and 43% (95% CI 34.0, 51.6). When all 3 criteria were required, the sensitivity and specificity were 43% (95% CI 24.5, 62.8) and 92% (95% CI 85.3, 95.7). Conclusions AUS should not be used in isolation to diagnose pancreatitis and is a poor indicator of severity.

“…However, concentrations of canine pancreas‐specific lipase by quantitative ELISA test (Spec cPL test, Idexx Laboratories) are increased in dogs with HAC without clinical evidence of pancreatitis compared to healthy dogs . A good agreement and strong correlation has been shown between lipase activity measured by the DGGR assay and the Spec cPL test in several studies, and thus finding increased lipase activity in dogs with HAC in our study was not unexpected. Whether HAC is a predisposing factor for pancreatitis remains unresolved.…”

Section: Discussionsupporting

confidence: 80%

Evaluation of individual low‐dose dexamethasone suppression test patterns in naturally occurring hyperadrenocorticism in dogs

Bennaim

Shiel

Forde

et al. 2018

BackgroundDogs with hyperadrenocorticism (HAC) may be more mildly affected at the time of diagnosis today, which could influence the prevalence of associated clinical and clinicopathological abnormalities and diagnostic test performance. Different low‐dose dexamethasone suppression test (LDDST) result patterns have not been evaluated individually.ObjectivesTo assess the current features of HAC and evaluate if the diagnostic test performance of individual LDDST result patterns differ.AnimalsOne hundred and twenty‐three dogs undergoing investigation for HAC.MethodsRetrospective evaluation of dogs in which a LDDST was performed and HAC confirmed or excluded by alternative means. Cases with basal cortisol concentrations (t 0) < 1 μg/dL were excluded. Each LDDST result was classified as (a) complete suppression (t 3 and t 8 < 1 μg/dL), (b) lack of suppression (t 3 and t 8 > 1 μg/dL and both > 50% t 0), (c) partial suppression (t 3 and t 8 > 1 μg/dL but either < 50% t 0), (d) escape (t 8 > 1 μg/dL and t 3 < 1 μg/dL) or (e) inverse (t 3 > 1 μg/dL and t 8 < 1 μg/dL) pattern.ResultsFifty‐nine (48%) dogs were diagnosed with HAC and 64 (52%) with non‐adrenal illness. Hyperadrenocorticism cases had similar clinicopathological abnormalities compared to previous reports. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (95% confidence interval [CI]) of the LDDST for diagnosing HAC were 96.6 (91.9‐100)%, 67.2 (55.7‐78.7)%, 73.1 (63.2‐82.9)%, and 95.6 (89.5‐100)%, respectively. Lack of suppression pattern had the highest PPV (93.9 [85.8‐100]%) followed by the partial suppression pattern (67.9 [50.6–85.2]%) and escape or inverse pattern (36.8 [15.1–58.5]%).Conclusions and Clinical ImportanceA lack of suppression LDDST pattern has the highest PPV for diagnosing HAC followed by a partial suppression pattern. By contrast, the escape or inverse pattern provided limited support of HAC.