A multi-institutional study evaluating the diagnostic utility of the spec cPL™ and SNAP® cPL™ in clinical acute pancreatitis in 84 dogs.

BACKGROUND: Pancreas-specific lipase is reported to aid in diagnosing acute pancreatitis (AP) in dogs but has not been rigorously evaluated clinically. HYPOTHESIS/OBJECTIVES: To describe variability of disease in dogs with suspected clinical AP, and to evaluate accuracy of 2 pancreatic-specific lipase immunoassays, Spec cPL (SPEC) and SNAP cPL (SNAP), in diagnosing clinical AP. We hypothesized that SPEC and SNAP provide better diagnostic accuracy than serum amylase or total lipase. ANIMALS: A total of 84 dogs; 27 without AP and 57 with clinical signs associated with AP. METHODS: Multicenter study. Dogs were prospectively enrolled based upon initial history and physical examination, then retrospectively classified into groups according to the likelihood of having clinical AP by a consensus of experts blinded to SPEC and SNAP results. Bayesian latent class analyses were used to estimate the diagnostic accuracy of SPEC and SNAP. RESULTS: The estimates for test sensitivities and specificities, respectively, ranged between 91.5-94.1% and 71.1-77.5% for SNAP, 86.5-93.6% and 66.3-77.0% for SPEC (cutoff value of 200 µg/L), 71.7-77.8% and 80.5-88.0% for SPEC (cutoff value of 400 µg/L), and were 52.4-56.0% and 76.7-80.6% for amylase, and 43.4-53.6% and 89.3-92.5% for lipase. CONCLUSIONS AND CLINICAL IMPORTANCE: SNAP and SPEC have higher sensitivity for diagnosing clinical AP than does measurement of serum amylase or lipase activity. A positive SPEC or SNAP has a good positive predictive value (PPV) in populations likely to have AP and a good negative predictive value (NPV) when there is low prevalence of disease.

[Axel Laurent-Christensen: a doctor "with feeling for snow"]. / Axel Laurent-Christensen, en laege med 'fornemmelse for sne'.

In 1950 the district medical officer of Qaqortoq/Julianehåb, Axel Laurent-Christensen retired after having served in this position since 1930. Afterwards, during the years 1950-55, he was a medical officer in Aklavik, NWT, Canada. Here he had the opportunity to compare the arctic Canadian health care with the Greenland health care system. In his diary, of which selected parts are given in the present paper, he has commented on the differences. In the 1950's the Canadian system was highly centralized with the well-equipped Charles Camsell Indian Hospital in Edmonton as the center. The Greenland health service, on the other hand, was decentralized, based on small surgically staffed peripheral hospitals. The development of these two health care systems during the past 50 years has accentuated these differences. Estimated by the infant mortality, the efficiency of the Greenland health care system was superior to the Canadian during the 1950's, whereas in the 1990's, the Canadian health service is vastly superior.