title: Evaluation of plasma protein C activity for detection of hepatobiliary disease and portosystemic shunting in dogs.
abstract: OBJECTIVE
  To determine the diagnostic value of protein C (PC) for detecting hepatobiliary disease and portosystemic shunting (PSS) in dogs.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  238 clinically ill dogs with (n = 207) and without (31) hepatobiliary disease, including 105 with and 102 without PSS.
  
  
  METHODS
  Enrollment required routine hematologic, serum biochemical, and urine tests; measurement of PC activity; and a definitive diagnosis. Total serum bile acids (TSBA) concentration and coagulation status, including antithrombin activity, were determined in most dogs. Dogs were grouped into hepatobiliary and PSS categories. Specificity and sensitivity were calculated by use of a PC cutoff value of 70% activity.
  
  
  RESULTS
  Specificity for PC activity and TSBA concentrations was similar (76% and 78%, respectively). Best overall sensitivity was detected with TSBA, but PC activity had high sensitivity for detecting PSS and hepatic failure. Protein C activity in microvascular dysplasia (MVD; PC > or = 70% in 95% of dogs) helped differentiate MVD from portosystemic vascular anomalies (PSVA; PC < 70% in 88% of dogs). A receiver operating characteristic curve (PSVA vs MVD) validated a useful cutoff value of < 70% activity for PC.
  
  
  CONCLUSIONS
  Combining PC with routine tests improved recognition of PSS, hepatic failure, and severe hepatobiliary disease and signified a grave prognosis when coupled with hyperbilirubinemia and low antithrombin activity in hepatic failure. Protein C activity can help prioritize tests used to distinguish PSVA from MVD and sensitively reflects improved hepatic-portal perfusion after PSVA ligation.
authors.affiliation: Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853, USA.
authors.forename: Olivier
authors.initials: O
authors.lastname: Toulza
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Center
authors.forename: Marjory B
authors.initials: MB
authors.lastname: Brooks
authors.forename: Hollis N
authors.initials: HN
authors.lastname: Erb
authors.forename: Karen L
authors.initials: KL
authors.lastname: Warner
authors.forename: Wendy
authors.initials: W
authors.lastname: Deal
mesh_terms: D000818:Animals; D001647:Bile Acids and Salts / Q000097:blood; D001660:Biliary Tract Diseases / Q000097:blood / Q000175:diagnosis / Q000662:veterinary*; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D004283:Dog Diseases / Q000097:blood / Q000175:diagnosis*; D004285:Dogs; D005260:Female; D008107:Liver Diseases / Q000097:blood / Q000175:diagnosis / Q000662:veterinary*; D008297:Male; D011168:Portal System / Q000002:abnormalities*; D011446:Prospective Studies; D011486:Protein C / Q000032:analysis; D012016:Reference Values; D012680:Sensitivity and Specificity
chemical_list: D001647:Bile Acids and Salts; D011486:Protein C