Abstract
Simple SummaryFeline pancreatitis is a common disease with diagnostics requiring a combination of clinical, laboratory and imaging methods. Measuring of pancreatic lipase concentration is the laboratory mainstay of feline pancreatitis diagnostics. It can be done using immunoenzymatic assay (feline pancreatic immunoreactivity, fPLI) or colorimetric assay based on hydrolyzing a special substrate (DGGR) to a color product. A DGGR-lipase assay is manufactured by various companies. Studies carried out in cats on the DGGR-lipase assay of a single manufacturer have shown a high agreement with fPLI, however studies in dogs indicate that the performance of assays of different manufacturers may vary considerably. One of the largest Polish veterinary laboratories working 24/7 in the largest Polish cities offers the DGGR-lipase assay of a large Polish laboratory solutions provider. The values obtained in this assay are higher than those yielded by the traditional DGGR-lipase assay validated in studies carried out so far. Therefore, we decided to evaluate the agreement between the DGGR-lipase assay of the Polish manufacturer and fPLI. The agreement proved to be as high as for the traditional assay.The colorimetric catalytic assay based on the use of 1,2-o-dilauryl-rac-glycero-3-glutaric acid-(6′-methylresorufin) (DGGR) ester as a substrate for pancreatic lipase activity is commonly used for the diagnosis of pancreatitis in dogs and cats. Even though the assay has generally been shown to yield consistent results with feline pancreatic lipase immunoreactivity (fPLI) assay, the agreement may vary between assays of different manufacturers. In this study, the chance-corrected agreement between a DGGR-lipase assay offered by one of the biggest providers of diagnostic solutions in Poland and fPLI assay was investigated. The study was carried out on 50 cats in which DGGR-lipase activity and fPLI were tested in the same blood sample. The chance-corrected agreement was determined using Gwet’s AC1 coefficient separately for the fPLI assay’s cut-off values of >3.5 μg/L and >5.3 μg/L. The DGGR-lipase activity significantly positively correlated with fPLI (Rs = 0.665; CI 95%: 0.451, 0.807, p < 0.001). The chance-corrected agreement between the fPLI assay and DGGR-lipase assay differed considerably depending on the cut-off values of the DGGR-lipase assay. When the cut-off value reported in the literature (>26 U/L) was used, it was poor to fair. It was moderate at the cut-off value recommended by the laboratory (>45 U/L), and good at the cut-off value recommended by the assay’s manufacturer (>60 U/L). The highest agreement was obtained between the fPLI assay at the cut-off value of 3.5 μg/L and the DGGR-lipase assay at the cut-off value of 55 U/L (AC1 = 0.725; CI 95%: 0.537, 0.914) and between the fPLI assay at the cut-off value of 5.3 μg/L and the DGGR-lipase assay at the cut-off value of 70 U/L (AC1 = 0.749; CI 95%: 0.577, 0.921). The study confirms that the chance-corrected agreement between the two assays is good. Prospective studies comparing both assays to a diagnostic gold standard are needed to determine which of them is more accurate.
Highlights
Diagnosing feline pancreatitis is challenging as the tests used in clinical practice have limited accuracy when compared to histopathology, which is considered to be the gold standard [1]
An feline pancreatic lipase immunoreactivity (fPLI) assay of Laboklin (Bad Kissingen, Germany) has been introduced onto the market [5]. fPLI results are currently interpreted according to the reference interval (RI) of ≤3.5 μg/L and the cut-off value indicating pancreatitis of >5.3 μg/L; these are based on a small-scale retrospective study available only in the form of an abstract and never published as a peer-reviewed article [6]
FPLI ranged from 0.6 to 50 μg/L with a median (IQR) of 3.5 (1.3 to 8.9) μg/L. fPLI was within the RI (≤3.5 μg/L) in 26 cats (52%) and >5.3 μg/L in 20 cats (40%)
Summary
Diagnosing feline pancreatitis is challenging as the tests used in clinical practice have limited accuracy when compared to histopathology, which is considered to be the gold standard [1]. Diagnosis is made in daily medicine based on clinical signs, pancreatic lipase concentration or activity and the appearance of the pancreas and surrounding mesentery in the abdominal ultrasound examination [1]. FPLI results are currently interpreted according to the reference interval (RI) of ≤3.5 μg/L and the cut-off value indicating pancreatitis of >5.3 μg/L; these are based on a small-scale retrospective study available only in the form of an abstract and never published as a peer-reviewed article [6]. As the fPLI assay is currently only offered by two commercial laboratories, it is relatively expensive and has a turnaround time of 1–3 days. An in-clinic point-of-care fPLI test (Snap fPLTM; Westbrook, ME, USA), useful in emergency practice, provides only binary results with the cut-off value set at an fPLI of 3.5 μg/L [7]
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