Concurrent hepatopathy in dogs with gallbladder mucocele: Prevalence, predictors, and impact on long-term outcome

Sara A. Jablonski, Yue Xiang (Polly) Chen, Jarod E. Williams, Jessica A. Kendziorski, Rebecca C. Smedley

Background
Gallbladder mucocele (GBM) is a significant biliary tract disorder in dogs, characterized by mucosal hyperplasia and mucus accumulation in the gallbladder. While the histologic abnormalities in the gallbladder have been well-studied, the prevalence, predictors, and clinical implications of concurrent hepatic abnormalities in GBM cases remain underexplored. This study aimed to investigate the prevalence of hepatic histologic abnormalities, their association with clinical outcomes, and the utility of the neutrophil-to-lymphocyte ratio (NLR) as a biomarker in dogs with GBM.

Methods
A retrospective analysis was conducted on 52 dogs diagnosed with GBM via histopathology, undergoing cholecystectomy and concurrent liver biopsy. Data from two veterinary institutions (2016–2020) were reviewed, including clinical parameters, histologic liver abnormalities, and survival outcomes at 1, 3, and 12 months post-surgery. Histological evaluation of liver tissues assessed abnormalities such as fibrosis, biliary hyperplasia, portal inflammation, and necrosis. NLR was calculated from pre-operative bloodwork. Statistical analyses, including Fisher's exact test and Mann-Whitney U tests, examined the relationships between hepatic findings, survival, and NLR.

Results
- Prevalence of Hepatic Abnormalities:
- 98% of dogs had at least one hepatic abnormality, with hepatic fibrosis (73%), biliary hyperplasia (56%), and portal inflammation (48%) being the most common.
- Survival Outcomes:
- Dogs with higher portal fibrosis scores had decreased survival at all post-surgical time points (1, 3, and 12 months, p ≤ 0.04).
- Other histologic abnormalities (e.g., cholangitis, centrilobular hepatitis) did not significantly affect survival rates.
- NLR as a Biomarker:
- Dogs with hepatic necrosis (p = 0.006) and cholangitis/cholangiohepatitis (p = 0.02) exhibited significantly higher NLRs compared to unaffected dogs.
- No significant differences in survival were observed between dogs with and without these lesions.

Limitations
- Retrospective design introduced variability in treatment protocols and data completeness.
- Limited sample size and incomplete follow-up for some dogs hindered survival analysis.
- The lack of standardized criteria for assessing histologic features could affect reproducibility.
- Causes of death were not always clearly linked to hepatic disease, especially in elderly dogs.

Conclusions
Hepatic histologic abnormalities are nearly ubiquitous in dogs with GBM. Advanced fibrosis may correlate with reduced survival, underscoring the importance of early surgical intervention. Elevated NLR appears associated with certain inflammatory hepatic lesions but requires further validation as a prognostic biomarker. This study highlights the clinical significance of concurrent liver pathology in managing GBM cases.

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