Pancreatite acuta canina: complicanze e fattori prognostici

To date, canine AP is an increasing-prevalence disease, potentially life- threatening, especially when complications occurs. Since, at today, a few studies have taken into account prognostic factors/markers in canine AP, this project was born to study potential prognostic factors in canine AP, both clinical and clinicopathological. So far in humans, the two main common and potentially fatal comorbidities are renal and pulmonary complications, which are widely studied in human medicine (Kumar et al. 2015; Zhou et al. 2015; Akbarshahi, 2012; Browne & Pitchumoni, 2006; Pastor, 2003), but a little about them is known in canine AP. To date, only few studies investigated the potential role of renal injury in dogs with AP. Firstly, Mansfield and colleagues insert the alterations of azotaemia in their clinical severity index; however, being part of this scoring system, the prognostic relevance of azotaemia cannot be understood (Mansfield et al. 2008). In another study, by Papa et al. (2011), about half of the study population had hyperazotemia, even if it was not associated with the mortality (Papa et al. 2011). In addition, no clinical studies have been conducted on pulmonary complications in dogs with AP. In veterinary literature, only one case report (Lopez et al. 1995) and one study on the histopathology of lungs and pancreas (Vrolyk et al. 2017) are present. Our PhD project was mainly divided in two main parts: the first one was built in order to study various aspects of potential renal complications, and the second one was set up to study pulmonary complications. Besides these two main subjects, we conducted other studies, using the same population, on potential prognostic markers related to the magnitude of systemic inflammation. Based on the results of the studies reported in the previous sections, during canine AP renal complications, from signs of urinary kidney injury to AKI, may occur. Besides AKI, which need a prompt therapy, including haemodialysis in the worse cases, other less severe signs of renal injury have to be investigated, especially with early markers (e.g. symmetric dimethylarginine (SDMA) and Neutrophil Gelatinase-Associated Lipocalin (NGAL)). As for humans with AP, pulmonary complications, from mild abnormalities in the arterial blood gas to acute lung injury (ALI), appears to be quite common and associated with higher mortality rates. This particular aspect, which the first report in veterinary medicine, is the first useful step for clinicians to propose and investigate this particular aspect of AP. In addition, in the worse cases, especially when ALI or acute respiratory distress occurs, in-hospital invasive support therapy may be needed (e.g. mechanic ventilation). Finally, since the majority of AP complications are caused mainly by the systemic inflammation, we investigated the CRP/ALB ratio and the ADMA. Both these markers resulted useful in establishing dogs’ prognosis, and thus resulted interesting markers that have to be evaluated in dogs with AP. For future prospective, it will be interesting to evaluate these markers during the patients follow up, in order to obtain information on their trend during hospitalization and maybe during the recovery for AP.