Prognostic markers and assessment of a previously published clinical severity index in 109 hospitalised dogs with acute presentation of pancreatitis

Abstract

BackgroundAcute pancreatitis (AP) is common in dogs. Nevertheless, validated clinical severity index (CSI) scoring systems to assess severity and guide treatment in current, large-scale studies are unavailable.MethodsThis is a retrospective study including 109 dogs. Pancreatitis was diagnosed based on clinical signs, abdominal sonographic evidence, positive pancreatic lipase assays and experts’ assessment consensus.ResultsThe survival rate was 75 per cent (82 dogs). Azotaemia and presence of local complications (ie, ascites) and secondary complications (ie, acute kidney injury and acute respiratory distress syndrome) were significantly associated with death. In agreement with the previously published CSI, respiratory anomalies were significantly associated with death. However, in disagreement with that study, high scores in the kidney and local abdominal complication categories and the sum of scores of all nine categories, but not high gastrointestinal category score, were also significantly associated with death. A final CSI score of at least 4 was associated with death.ConclusionsThis study has validated a nine-category CSI, proven a useful assessment tool in dogs with AP. Several previously reported and novel prognostic markers were assessed.

Protease inhibitors, inflammatory markers, and their association with outcome in dogs with naturally occurring acute pancreatitis

“…Indeed, several results that were borderline significant (ie, higher cPLI concentrations in nonsurvivors) might become significant in larger studies. Nevertheless, several present findings (eg, lack of association between cytokine concentrations and death, associations of ATA and CAPS score with death) are consistent with previous results, 25,32,33 strengthening our conclusions. Second, the dynamic nature of inflammation in naturally occurring AP largely depends on the duration of clinical signs, as evident in differences between early and late presentations.…”

“…4,5,11,31,32 The latter include SIRS and MODS, and their manifestations contribute to the CSI scores, which have been associated with the prognosis of AP in both humans and dogs. 4,5,11,[31][32][33] In our study, concentrations of pancreatic lipase (cPLI and DGGR lipase) and inflammatory cytokines did not differ between survivors and nonsurvivors of AP. The former finding is in disagreement with previous studies of AP in dogs, in which markedly increased cPLI concentrations 39 or serum lipase activities 40 were more frequent in nonsurvivors.…”

“…Local abdominal complications included peripancreatic or diffuse effusion, cholestasis, and intestinal ileus 31,33 . Systemic complications included: (1) acute kidney injury (AKI), diagnosed based on the International Renal Interest Society grading system 34 ; (2) disseminated intravascular coagulation (DIC), defined as presence of anomalies in each of the following categories: coagulation factor and platelet consumption (≥2 of the following: thrombocytopenia [platelet count, <143 × 10 9 /L], prolonged aPTT [aPTT, >20 s; RI, 17.4‐11.0 s] and PT [PT, >10 s; RI, 8.4‐6.0 s]), coagulation factor inhibitor consumption (hypoantithrombinemia [ATA <87%; RI, 87‐140%]) and increased fibrinolysis (D‐D concentration > 500 ng/mL; RI, <250 ng/mL) 35 ; (3) Hypercoagulability (suspected when PT, aPTT and platelet count were all within RI, while D‐D concentration was increased, or with presence of clinical or imaging evidence of thrombosis [ie, absent femoral pulse in absence of hypotension, Doppler‐ultrasonography evidence of a thrombus interrupting blood flow]) 36 ; and (4) SIRS diagnosed based on criteria used in the CAPS scoring system 32 (Appendix S1).…”

“…Clinical disease severity scores were assigned to each dog with AP using 3 previously published canine AP clinical scoring indexes (CSIs), 31,32 including a recently validated organ score CSI, 31,33 the canine acute pancreatitis severity (CAPS) and the simplified CAPS (sCAPS 32 ; Appendix S1).…”

“…Local abdominal complications included peripancreatic or diffuse effusion, cholestasis, and intestinal ileus. 31,33 .…”