Prognostic Markers in Feline Hepatic Lipidosis

Hepatic lipidosis is a common liver disease in cats that is associated with high morbidity and mortality. Aggressive therapy to reverse the catabolic state and hepatic failure resulting from prolonged anorexia is required.^1-3 Anorexia may be precipitated by comorbidities (eg, GI disease, pancreatitis, cholangiohepatitis) or may be primary (ie, decreased food intake in a healthy animal due to stress-related environmental events or food refusal).

In this study, clinical and laboratory parameters were evaluated in 71 cats diagnosed with hepatic lipidosis (based on liver cytology or histopathology) to identify those associated with mortality. Cats with hepatic lipidosis were older than those in the control group, and female cats were overrepresented.^1-3 Primary idiopathic hepatic lipidosis resulting from stress-related anorexia accounted for 20% of cases, which emphasizes the importance of educating pet owners about prevention.

Severity of hepatobiliary enzyme elevation was not associated with survival, whereas markers of hepatic dysfunction (eg, hypoalbuminemia, hyperbilirubinemia, hypocholesterolemia, hyperammonemia) had greater impact on survival, regardless of whether they were observed at time of presentation or developed during hospitalization. Hypokalemia, hyponatremia, hypochloremia, and hypophosphatemia were associated with death, although these are correctable and may be indicative of unbalanced fluid therapy and/or overhydration.²

Recovery from hepatic lipidosis has been best predicted by a 50% progressive decrease in bilirubin concentration during the first 7 to 10 days of reinstitution of nutrition.² Overall mortality in this study was 38%.

Key pearls to put into practice:

Aggressive therapy is often necessary to increase the chance of patient survival and complete recovery; early reintroduction of nutrition remains vital.

Close monitoring of electrolytes (ie, sodium, chloride, potassium, phosphorous) during hospitalization and aggressive correction of abnormalities are recommended to limit mortality.

The underlying cause of the anorexic event leading to hepatic lipidosis is not a prognostic factor.

Cats of all BCSs—not just obese cats—can develop hepatic lipidosis.