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

Abstract

Background: Lipase activity and pancreatic lipase immunoreactivity (PLI) have not been compared in dogs hospitalized for acute pancreatitis (AP). Objectives: To describe the progression of lipase activity and PLI, and correlations with clinicopathologic features in dogs with AP. Animals: Thirty-nine dogs with AP based on clinical signs and lipase activity >350 U/L (reference interval [RI], 24-108 U/L). Methods: Retrospective study. Lipase activity (LIPC Roche), PLI (SpecPL), and clinical signs were recorded daily. Admission (d1) data (clinical, laboratory, and ultrasound [US] findings), and clinical signs during hospitalization (d2-d3) were assessed for correlation with lipases. Results: Median (range) duration of clinical signs before presentation was 2 days (1-7 days). Median (range) lipase activity and PLI at d1 were 1070 U/L (range, 357-1500 U/L) and 1111 μg/L (range, 292-1500 μg/L). Strong correlation between assays at d1 (rs 0.96; P < .0001; n = 39), remained equally strong on d2 (rs 0.964; P < .0001; n = 39), and d3 (rs 0.966; P < .0001; n = 22). On d2, lipase activity and PLI were within RI in 13/39 (33%) and 18/39 (46%) of cases. Lipase activities were minimally increased (median, 124 U/L) in 5 dogs with d2 PLI <200 μg/L. On d3, 4 more dogs had normal lipase activity and PLI, and the nature and magnitude of change were always the same for both assays. Clinical signs were not associated with lipases. Only a hyperechoic mesentery, but not an US diagnosis of AP, correlated significantly with lipase activity and PLI. Conclusions and clinical importance: Lipase decreases rapidly to near or within RI within 2 days of treatment in the majority of dogs with AP. Both lipase assays yielded virtually identical results. Mesenteric echogenicity may be an early marker of AP in dogs.

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

“…Our CRP findings mirror that of a recent study that noted minimal changes in CRP concentrations during a 48 hour (brief) period of monitoring 25 . Lipase activity decreases to near or within RI within approximately 2 days of treatment this is similar to our group in which the median cPLI concentration at day 2 was 402.5 μg/L, just above the diagnostic threshold for pancreatitis 16 . When compared to cPLI, CRP and OH, the composite ultrasonographic score (UPASS) did not drop significantly during the early phases of the disease and significant decreases were only noted between days 0 and 28, and between days 2 and 28, suggesting a slower rate of improvement relative to inflammatory biomarkers and clinical signs.…”

“…3,26 The results of this study, in conjunction with 2 prior studies, clearly demonstrates that the timeline for detection of abnormal lipase and ultrasonographic findings differ both in onset of abnormalities and their resolution. 15,16 This helps to explain discrepancies seen between biochemical and sonographic findings in prior studies, but further adds to the complexity of a diagnosis of pancreatitis. [13][14][15] Given that median cPLI concentrations decreased to just above the upper end of the RI during early hospitalization (by day 2), it would be imperative to maintain strict sampling timelines in future studies into pancreatitis in dogs, as even a small change in timeline could significantly affect the results of the study.…”

“…The prospective use of a longer follow up period and the use of an immunologic lipase assay in our study make the results of our study and the earlier studies complementary and further our understanding of biomarker and imaging findings over time in dogs with pancreatitis. 16,26 Given this future study designs should be cognizant of both prehospitalization and in-hospital time-…”

“…In this study we prospectively describe the progression of clinical signs, ultrasonographic findings, pancreatic lipase, and C‐reactive protein concentrations across a 28‐day period in dogs with clinically acute presentations of suspected pancreatitis 23 . This follow up period is longer than previously reported and allows for improved comparison between clinical, biochemical, and ultrasonographic indicators of pancreatitis 16 . Additionally we compare findings in dogs with baseline cPLI concentrations ≥400 μg/L with those <400 μg/L (with a concurrent abnormal SNAP cPL).…”

“…2011:238). These diagnostic discrepancies prompted additional studies in this area 12,15,16 . These studies strengthened evidence that ultrasonographic evidence of pancreatitis and lipase activity do not follow the same clinical timeline for onset and resolution after pancreatic injury but are limited by the short‐term nature of follow up, missing or limited data, the presence of concurrent disease, exclusion of suspected CP cases, or their retrospective nature.…”