Lipase and Pancreatitis
Old technology for determining total lipase was often inaccurate in ruling in/out pancreatitis. SVS Laboratories uses a new DGGR method for assessing total lipase which has been shown to be relatively sensitive and specific for detecting pancreatitis in dogs and cats.
Total lipase in a Sick Animal Panel, either < 100 IU/L or > 200 IU/L requires no further testing, whereas pancreatic lipase is recommended in dogs with clinical signs suggesting pancreatitis and total lipase between 100-200 IU/L.
Cats with suspicious clinical signs should initially be tested with total lipase, and <26 IU/L should be further assessed with pancreatic lipase if pancreatitis remains a differential.
Until recently the use of total lipase has not been particularly useful in diagnosing pancreatitis in dogs and has been so far off the mark in cats that it is not often assessed. The Snap and Spec pancreatic lipase tests filled a gap by providing support for the inclusion or exclusion of pancreatitis in symptomatic patients. However, the tests are expensive and in the case of Spec lipase, a one to two day turn-around may occur.
SVS Laboratories uses the DGGR method for assessing total lipase which has been shown to be more sensitive and specific for detecting pancreatitis in both dogs and cats.
A comparison of serum results from dogs with suspected pancreatitis found that all dogs with total lipase activity < 100 IU/l had a Normal Snap cPL and all dogs with total lipase > 200 IU/l had an Abnormal Snap cPL. Dogs with total lipase activity 100-200 IU/l had a mix of Normal and Abnormal results. These findings are similar to those determined by Kook et. al., (2014) who found a grey zone between 109-216 IU/l when comparing DGGR with pancreatic lipase and ultrasonography.
Consequently, we recommend testing pancreatic lipase only in dogs with clinical signs suggesting pancreatitis and total lipase that falls between 100 and 200 IU/l.
Unfortunately, there is still no gold standard for detecting pancreatitis in cats.
A study by Oppliger et. al. (2013) found that all cats with acute pancreatitis diagnosed by histopathology had a DGGR result of >26 IU/l, an Abnormal Snap fPL and a Spec fPL > 5.4 ug/l.
However, chronic pancreatitis is relatively common in cats and clinical signs are so similar to acute pancreatitis that they can be differentiated on clinical grounds. In these cats none of the tests showed high sensitivity with the DGGR showing 37%, the Snap fPL 58% and Spec fPL > 5.4 ug/l, 47%.
Specificity is also modest with all tests showing 63% Sp meaning that about 1/3 of cats with blood results suggesting pancreatitis have histological evidence of pancreatic disease.
As a result, we suggest initially testing total lipase in cats with suspicious clinical signs and following with pancreatic lipase in animals with total lipase < 26 IU/l, if pancreatitis remains a differential.
PH Kook, N Kohler, S Hartnack, B Riond, CE Reusch. Agreement of serum Spec cPL with the 1,2-o-dilauryl-rac-glycero glutaric acid-(6′-methylresorufin) ester (DGGR) lipase assay and with pancreatic ultrasonography in dogs with suspected pancreatitis.
J Vet Intern Med. 2014;28(3):863-70.
S Oppliger, S Hartnack, B Riond, C E Reusch, P H Kook. Agreement of the serum Spec and 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) ester lipase assay for the determination of serum lipase in cats with suspicion of pancreatitis.
J Vet Intern Med. 2013;27(5):1077-82.
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