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

Abstract

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 (rs = .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.

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

“…Inappetence or anorexia (94%) and abdominal pain (60%) were more common compared with our findings, but other clinical signs were approximately equally frequent 4 . So far, lipase results have only once been compared with clinical signs and, in contrast to our results, lipase activity was significantly higher in dogs presented with abdominal pain, vomiting, hematemesis, and lethargy 11 . Differences are likely related to study design.…”

“…A suspicion (US evidence of pancreatic mass lesions) or confirmation of pancreatic carcinoma was an exclusion criterion. Diagnosis of AP was based on at least 1 of the following signs (lethargy, anorexia, vomiting, abdominal pain, diarrhea) of ≤7 day duration, and DGGR‐lipase activity >350 U/L (LIPC, Roche on Cobas, Roche Diagnostics, Rotkreuz, Switzerland using DGGR as substrate; RI, 24‐108 U/L) 9,11 . This cutoff of 350 U/L is based on our clinical experience.…”

“…11 With shorter disease duration, dogs had significantly higher lipase activities but US was not positive significantly more often for pancreatitis. 11 So far, the relationship between lipase and pancreatic US has not been assessed in dogs with clearly defined acute disease. Therefore, we had the following objectives: First, to describe the time course of DGGR-lipase activity and PLI and correlations with clinical signs in dogs with AP.…”

“…Comparison of lipase assays over time also has not been examined. Besides lipase measurement, pancreatic ultrasonography (US) is regarded the second cornerstone of a diagnosis of AP, although agreement and correlation of lipase activity and PLI concentration with pancreatic US have been repeatedly found to be low 9,11,13‐16 . Emerging evidence suggests that duration of clinical signs before presentation affects lipase results and US evidence of pancreatitis differently 11 .…”

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

“…While other diagnostic criteria such as ultrasonographic features were initially considered in study planning, they were ultimately deemed more subjective than cPLI concentration, particularly in the face of a multi-practice evaluation. Ultrasound is well-known to be affected by operator experience, patient discomfort, and the information provided to the sonographer at the time of evaluation [ 13 , 14 , 15 ]. Clinical signs were not eligible for study inclusion due to the objectives of the study.…”