Protease inhibitors, inflammatory markers, and their association with outcome in dogs with naturally occurring acute pancreatitis.
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BACKGROUND: Acute pancreatitis (AP) presumably is associated with pancreatic protease activation, protease inhibitor (PI) depletion, and inflammatory mediator secretion. OBJECTIVES: Examine PIs and inflammatory mediator concentrations in dogs with AP and their association with death. ANIMALS: Thirty-one dogs diagnosed with AP based on clinical signs, ultrasonographic findings, and increased canine pancreatic lipase immunoreactivity (cPLI) and 51 healthy control dogs. METHODS: Antithrombin and 2 -antiplasmin activity (ATA and 2 AP, respectively) and concentrations of 1 -proteinase inhibitor (1 PI), 2 -macroglobulin (2 MG), C-reactive protein (CRP), interleukins (ILs)-2,6,8 and tumor necrosis factor- (TNF-) were prospectively measured. Severity of AP was assessed by clinical severity scoring systems. RESULTS: Mortality rate was 19%. Antithrombin activity was lower (P = .004) and maximal CRP, IL-6, and TNF- concentrations higher (P<.04) in the AP group compared to the controls, whereas IL-2, IL-8, 1 PI, and 2 AP concentrations did not differ between groups. Serum 2 MG concentration was not reliably detected. Serum cPLI, CRP, and IL-6 concentrations were significantly and positively correlated. The ATA was lower (P = .04), and canine acute pancreatitis severity (CAPS) scores higher (P = .009) in nonsurvivors compared to survivors. Higher CAPS scores were associated (P< .05) with decreased ATA and increased cPLI, CRP, and IL-6 concentrations. CONCLUSIONS AND CLINICAL IMPORTANCE: Systemic inflammation in dogs with AP is manifested by increased inflammatory mediator concentrations, correlating with cPLI and CRP concentrations. Hypoantithrombinemia is associated with death. Serum concentrations of 2 AP and 1 PI are less useful prognostic markers. The CAPS score is a useful prognostic marker in dogs with AP.
