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

Abstract

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.

Evaluation of Disease Spectrum in Hospitalized Cats with Hyperlipasemia: Pancreatitis Alone Is Rare, Hyperlipasemia without Suspected Pancreatitis Is Common

“…It is quite possible that more cats fell into the NP group, because fewer cats in this group had a US examination. However, our results are in agreement with the previous literature that pancreatic US findings do not correspond well with lipase values [9,23,24]. The discrepancy between lipase and ultrasound results may be due to the fact that not all parts of the pancreas were seen during US examinations, that cats may have been highly acutely ill and pancreatic changes were not yet visible on US, or that cats with chronic pancreatitis had altered pancreata on US, but no increase in lipase.…”

“…Because cats with pancreatitis are usually nonspecifically ill and one of our aims was to assess how often sick cats with increased lipase are diagnosed with non-pancreatic diseases, we did not use predefined clinical signs as inclusion criteria, in order to not miss any cases. As it is still unknown at which lipase cutoff values pancreatitis is present [15,24] we included all cats with minimally increased lipase activity results compared to our current RI (6-26 U/L). The 30 U/L cutoff was chosen, as this value is currently emerging as our approximate new upper RI limit (n= 37 healthy cats included so far).…”

“…We hypothesized that pancreatitis alone would be rare and that most cats with pancreatitis would have at least one additional disease. Because of the nonspecific clinical signs in cats with pancreatitis and the well-known poor agreement of lipase with US evidence of pancreatitis [9,[23][24][25], we further hypothesized that many cats with non-pancreatic diseases would not receive a clinical diagnosis of pancreatitis despite increased lipase values.…”

Effects of prednisolone on 1,2‐O‐dilauryl‐rac‐glycero glutaric acid‐(60‐methylresorufin) ester‐lipase activity and pancreatic lipase immunoreactivity in healthy cats

“…These new calculations based on a larger number of healthy cats resulted in a decision threshold ≥8.8 μg/L that was again denoted as “consistent with pancreatitis.” 14 Those higher cutoffs fit the observation that increased lipase concentrations are found in clinically normal cats, although it remains unclear whether these cats ultimately have subclinical pancreatitis or not. These new PLI cutoffs are in contrast to the clinical assessment of disease severity markers in 45 cats with suspected pancreatitis in another recent study, where 32/45 (71%) cats with suspected pancreatitis had PLI concentrations <3.5 μg/L 25 …”

“…These new PLI cutoffs are in contrast to the clinical assessment of disease severity markers in 45 cats with suspected pancreatitis in another recent study, where 32/45 (71%) cats with suspected pancreatitis had PLI concentrations <3.5 μg/L. 25 The new PLI cutoffs do not affect our results and conclusions, as all PLI results >3.5 μg/L at baseline and during prednisolone treatment were also >4.4 μg/L, and the 1 cat with increased lipase values had much higher results.…”