A retrospective study of oral prednisolone treatment in canine chronic hepatitis

Figures & data

Table 1. Variables collected from medical records and liver histopathology reviews (n = 36).

Data categories	Variables
Medical history	Concurrent diseases and current medication administration
Biochemistry markers	Total alkaline phosphatase (AP), heat-stable, steroid-induced alkaline phosphatase (AP-65), alanine aminotransferase (ALT), fasting total serum bile acids (sBA), ammonia, urea, creatinine, glucose, total serum protein (TP), albumin, prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen
Haematological markers	Haematocrit (Ht), leukocytes and differentiation, thrombocytes
Histopathological findings	Grading of necroinflammatory activity and fibrosis and cirrhosis, grading for copper content and distribution; and presence of steroid-induced hepatopathy
Treatment	Medical therapy; type and duration
Follow-up	Outcome after treatment (complete remission or recurrence of clinical signs, or residual disease), survival time after diagnosis, and presumable cause of death (clinical signs prior to death related to hepatitis or not)

Table 2. Normalization of coagulation in 10 dogs with chronic idiopathic hepatitis after 1 week of prednisolone (1 mg/kg BW/day) oral treatment.

	Before treatment			After treatment
	PT	APTT	Fibrinogen	PT	APTT	Fibrinogen
Reference intervals	7.2–9.9 s	13.2–18.2 s	1.0–2.7 g/L	7.2–9.9 s	13.2–18.2 s	1.0–2.7 g/L
Dog no.
1	13	14.1	0.7	7.7	18.4	1.4
2	13.7	25.2	0.9	12	18	1.1
3	11.1	23.4	0.5	8.6	17.7	1.8
4	11.7	19.6	0.9	10.7	17.5	1.6
5	8.9	11.8	0.5	7.1	12	1.3
6	14.4	23.4	0.5	11.3	17.9	1.2
7	10	18	0.8	8	10	1.2
8	12	19	0.6	8	12	1.6
9	9	17	0.7	8	14	1.0
10	11.5	23.4	0.5	6	22.8	1.3

Notes: No.: number; PT: prothrombin time; APTT: activated partial thromboplastin time; s: seconds.

Table 3. Semi-quantitative fibrosis and inflammatory scores in 36 dogs with chronic idiopathic hepatitis at the time of initial diagnosis.

Fibrosis score	No. of cases	Necro-inflammatory activity score (median (range))	No. of cases with SIH
1 (focal)	7	1 (0–3)	6
2 (bridging)	10	1 (0–4)	5
3 (cirrhosis)	19	2 (0–4)	8

Notes: No.: number; SIH: steroid-induced hepatopathy; necroinflammatory activity: 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = marked, 5 = severe.

Table 4. Blood values before and after 6 weeks of prednisolone oral treatment (1 mg/kg BW/day)(n = 21).

				Mean ± SD
Variable	Reference intervals	Unit	No.	Before		After		P
Bile acids	0–10	μmol/L	10	51.2 ± 74.4	(7↑)	24.3 ± 20.5	(7↑)	0.295
AP	0–73	U/L	7	369.3 ± 319.3	(7↑)	565.6 ± 414.3	(6↑)	0.229
AP-65	<15% of AP	U/L	6	50.2 ± 62.9	(6↑)	289.7 ± 251.5	(5↑)	0.015
ALT	0–54	U/L	7	408.9 ± 247.1	(5↑)	364.1 ± 240.0	(5↑)	0.568
Total protein	55–72	g/L	2	64.0 ± 7.1	(0↓)	56.0 ± 1.4	(0↓)	0.276
Albumin	26–37	g/L	2	27.0 ± 4.2	(1↓)	26.0 ± 0.0	(0↓)	0.825
PT	7.2–9.9	S	21	8.5 ± 2.0	(6↑)	7.2 ± 1.1	(0↑)	0.009
APTT	13.2–18.2	S	21	14.3 ± 4.7	(6↑)	14.6 ± 3.5	(2↑)	0.450
Fibrinogen	1.0–2.7	g/L	21	2.0 ± 1.5	(4↓)	2.7 ± 0.8	(0↓)	0.004
Leukocytes	4.5–14.6	10^9/L	4	22.0 ± 7.4	(4↑)	30.6 ± 18.3	(3↑)	0.383

Notes: No.: number of dogs with available paired blood values; PT: prothrombin time; APTT: activated partial thromboplastin time; s: seconds; P = P-value; in brackets the number of dogs above (↑) or below (↓) the reference range.

The reference intervals have been determined in 80 healthy dogs with Analyse-It Software version 2.30, Leeds, UK.

Table 5. Paired semi-quantitative (inflammation and fibrosis) and qualitative (steroid-induced hepatopathy [SIH]) scoring (number of dogs with SIH) of liver histology before and after 6 weeks of prednisolone oral treatment (1 mg/kg BW/day) in dogs with chronic idiopathic hepatitis (n = 20).

	Median (range)
Parameter	T = 0	T = 6	P
Inflammation	1.5 (0–4)	1 (0–3)	0.103
Fibrosis	1.5 (0–3)	1.5 (0–3)	0.361
SIH	9	15	–

Notes: P = P-value; SIH: steroid-induced hepatopathy; T = 0, before prednisolone treatment; T = 6, after 6 weeks of prednisolone treatment.

Necro-inflammatory activity (0–5): 0 = none, 1 = slight, 2 = mild, 3 = moderate, 4 = marked, 5 = severe; fibrosis score (0–3): 0 = none, 1 = focal, 2 = bridging, 3 = bridging with architectural distortion or cirrhosis.

Figure 1. Follow-up of 36 dogs with chronic idiopathic hepatitis treated with prednisolone (1 mg/kg BW/day). Mean duration of prednisolone administration was 8.8 ± 5.4 weeks (mean ± SD).

Figure 2. Survival curves of 36 dogs after diagnosis with chronic idiopathic hepatitis and prednisolone treatment as calculated with the Kaplan–Meier estimate procedure. Censored cases are represented by vertical bars. A = dogs without cirrhosis (n = 17); B = all 36 dogs with chronic idiopathic hepatitis; C = dogs with cirrhosis (n = 19). Dogs without cirrhosis survived significantly (P < 0.016) longer than dogs with cirrhosis.