Evaluation of different blood tests in dogs with extrahepatic portosystemic shunts to assess shunt closure after surgical treatment

• Published in: Veterinary surgery 2022-10, Vol.51 (7), p.1142-1152
• Main Authors: Devriendt, Nausikaa, Paepe, Dominique, Serrano, Gonçalo, Rooster, Hilde
• Format: Article
• Language: English
• Subjects: Ammonia; Attenuation; Bile acids; Blood; Blood tests; Dogs; Hyaluronic acid; Lidocaine; Medical imaging; Scintigraphy; Sensitivity analysis; Shunts
• ISSN: 0161-3499; 1532-950X
• DOI: 10.1111/vsu.13840

Objective To determine the sensitivity and specificity of different individual and combined blood tests to assess extrahepatic portosystemic shunt (EHPSS) closure after gradual attenuation of EHPSS in dogs. Study design Clinical prospective study. Animals Twenty client‐owned dogs with EHPSS. Methods Fasting ammonia (FA), preprandial, postprandial, and paired serum bile acids (SBA), the lidocaine/monoethylglycylxylidide (L/MEGX) test, and serum hyaluronic acid (SHA) were performed at diagnosis, and 1, 3, and 6 months postoperatively. Transsplenic portal scintigraphy was performed to determine EHPSS closure 3 months postoperatively. Their sensitivity and specificity in determining shunt closure postoperatively were calculated. Results When assessing a single blood parameter, FA had the highest specificity (100%), whereas SHA and MEGX measured 15 min after lidocaine administration (T15) had the highest sensitivity (96.9% and 96.2%, respectively) for determining shunt closure postoperatively. The most promising blood test combinations were SHA (sensitivity 96.9%, specificity 81.8%), combined with the L/MEGX test (MEGX at T15: sensitivity 100%, specificity 72.4%) or the L/MEGX test (MEGX at T15) combined with either FA (sensitivity 100%, specificity 82.8%) or postprandial SBA (sensitivity 100%, specificity 81.5%). Conclusion Both SHA and the L/MEGX test were sensitive tests for determining shunt closure after gradual attenuation of EHPSS. Test performances could even be improved by combining these tests with each other or with traditional tests such as FA or postprandial SBA. Clinical significance Although SHA and the L/MEGX test are sensitive blood tests for determining EHPSS closure, especially when combined with traditional blood tests, imaging is still needed to confirm EHPSS closure.