October 30, 2018
Nivy R, Kaplanov A, Kuzi S, Mazaki-Tovi M, Yas E, et al. A retrospective study of 157 hospitalized cats with pancreatitis in a tertiary care center: Clinical, imaging and laboratory findings, potential prognostic markers and outcome. J Vet Intern Med. 2018 Oct 13;:e15317.
Pancreatitis is an increasingly realized cause of morbidity and mortality in cats, especially the acute necro-suppurative forms. Chronic pancreatitis may be subtler in its presentation but is still a cause of significant disease in cats. While diagnosis of pancreatitis is a challenge in itself, there is also a need to identify prognostics factors that may influence the survival of cats presenting with pancreatitis. Determining which patient and treatment factors have an effect on outcome will help to better prepare owners and tailor therapy to specific patients.
The purpose of this study was to determine prognostic factors for cats with pancreatitis admitted to a university teaching hospital. It was designed as a retrospective observational study of cats admitted over a 6-year period. Cats were eligible if they had clinical signs consistent with pancreatitis plus one or more of: positive SNAP fPL, elevated DGGR-lipase; ultrasonographic evidence of pancreatitis, or histological evidence of pancreatitis. Cats were classified as survivors if they lived to be discharged, and as non-survivors if they died or were euthanized in hospital.
One hundred fifty-six cats were enrolled in the study, with 94 males and 63 females (a significant and previously unreported sex difference). Most cats were neutered. Most cats were primarily indoors. 13.4% of cats had a potential cause of pancreatitis identified (ie organophosphate toxicity, recent anesthesia, GI FB, etc), while most were of unknown origin.
One hundred forty-four variables were compared between survivors and non-survivors. Bonferroni’s correction was applied to these (a statistical tool for comparison of multiple variables) which resulted in no variable being significant. Uncorrected values are discussed in the paper.
Factors associated with non-survival included pleural effusion, not eating while in hospital, the use of parenteral nutrition, temperature, weight loss, duration of clinical signs, low calcium, low glucose, and other factors. Hypoglycemia in particular was directly correlated with risk of death, with each 20mg/dl (1.11mmol/L) drop in BG correlated with a 13% decrease of risk in death.
Fever and the use of antibiotics were associated with increased odds of survival. The authors theorized that fever may be more common in cats that are not azotemic, and as such associated with a lower risk of death.
Antibiotic use was associated with a higher chance of survival in this study. The routine use of antibiotics in cats with simple pancreatitis is controversial, with many guidelines recommending reserving antimicrobials for complex cases or other associated with pancreatic abscesses, severe leukocytosis, fever, or other clinical findings consistent with infection. Other authors suggest that ascending, secondary, or concurrent infections are more common, and that antibiotic use may be warranted. In a retrospective study such as this, determining the role of antimicrobials is not possible, and the authors of this paper suggest prospective trials should be performed.
The authors concluded that hypoglycemia, ionized hypocalcaemia, and azotemia were negative prognostic indicators in cats with pancreatitis. Antimicrobial use was associated with a higher rate of survival, and parenteral nutrition with a lower rate. Some of these factors (such as hypoglycemia and hypocalcemia) are likely indicative of more severe disease and their association with lower survival is unsurprising. Other factors, such as antimicrobial use, are less clear in their role. The authors suggest that cats who received parenteral nutrition were likely too ill to receive oral nutrition or feeding tube placement, and hence it may not directly be associated with lower survival.
A significant limitation to this study was the retrospective nature, which meant that there was a lack of control and consistency between cases. This makes exact comparison of cases impossible, and also makes differentiating correlation and causation difficult. Another limitation was the loss of significance after Bonferroni’s correction which may reduce the significance of findings.
Despite these limitations, this paper provides valuable insight into the prognostic factors surrounding pancreatitis in cats. (MRK)
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