Relationship among plasma amino acids, C-reactive protein, illness severity, and outcome in critically ill dogs

Influence of intravenous 10% amino acids infusion on serum albumin concentration in hypoalbuminemic dogs

Objective

To evaluate the effect of parenteral amino acid application in hospitalized hypoalbuminemic dogs.

Materials and methods

Medical records of client-owned hypoalbuminemic dogs (albumin ≤ 25 g/L) were analyzed. Dogs receiving amino acids for only 1-2 days, receiving transfusions or surgery, or <6 months of age were excluded. Dogs were grouped as those receiving intravenous amino acids (AA, 80 dogs) over 3 days and longer, and those without additional amino acid treatment (CON, 78 dogs). Duration of hospitalization, albumin, and total protein concentrations were compared between groups by Mann-Whitney U test. Course of albumin and total protein concentration was evaluated by Friedman test and Dunn's multiple comparison test. Significance was set to p ≤ 0.05.

Results

Dogs in group AA received 10% amino acid solution intravenously over median 4 days (3-11 days). No significant differences regarding survival and adverse effects were observed between groups. Dogs of group AA had significantly longer duration of hospitalization (median 8 days; 3-33 days) compared to group CON dogs (median 6 days, 3-24 days; p < 0.001). Initial albumin concentration was lower in group AA compared to CON (p < 0.001). This difference was no longer present on day 2 (p = 0.134).

Conclusions and clinical relevance

Intravenous application of 10% amino acid solution in hypoalbuminemic dogs can improve albumin concentration after 2 days, but does not influence outcome.

Serial evaluation of thoracic radiographs and acute phase proteins in dogs with pneumonia

Background

Acute phase proteins (APP) may guide treatment of pneumonia in dogs but correlations with radiographic abnormalities are poorly characterized.

Objectives

Develop a thoracic radiographic severity scoring system (TRSS), assess correlation of radiographic changes with APP concentrations, and compare time to APP and radiograph normalization with duration of antimicrobials treatment.

Animals

Sixteen client‐owned dogs, 12 with aspiration pneumonia, and 4 with community‐acquired pneumonia.

Methods

Concentrations of C‐reactive protein (CRP), serum amyloid A (SAA), and haptoglobin were measured on days 1, 3, 7, 14, 28, and 60 and orthogonal 2‐view thoracic radiographs were obtained on days 1, 7, 14, 28, and 60. Treatment was clinician‐guided and blinded to APP concentrations. Radiographic severity scores were assigned by blinded, randomized retrospective review by 2 board‐certified radiologists with arbitration by a third radiologist.

Results

Median (interquartile range [IQR]) time to normalization of CRP (7 days [7‐14]) and SAA concentrations (7 days [7‐14]) were shorter than antimicrobial treatment duration (17.5 days [14.5‐33.5]; P = .001 and .002, respectively) and TRSS normalization (14 days [8.8‐52], P = .02 and .02, respectively). The CRP and SAA concentrations were positively correlated with TRSS (CRP r_s, 0.643; SAA r_s, 0.634; both P < .0001). Both CRP and SAA identified normal thoracic radiographs area under the curve (AUC) 0.873 and 0.817, respectively, both P < .0001. Interobserver agreement for TRSS assignment was moderate (κ, .499; P < .0001).

Conclusion and Clinical Importance

Concentrations of CRP and SAA normalized before radiographic resolution and before clinicians discontinued antimicrobial treatment. The CRP and SAA concentrations may guide duration of antimicrobial treatment for dogs with pneumonia.

Measurement and clinical applications of C-reactive protein in gastrointestinal diseases of dogs

C-reactive protein (CRP) is a positive acute-phase protein, serum concentrations of which increase nonspecifically in response to inflammatory processes of the dog. As such, it can aid in the identification of inflammatory disease and, maybe more importantly, the objective monitoring of disease progression. In dogs, CRP is frequently used to evaluate dogs with gastrointestinal diseases, such as chronic inflammatory enteropathies (also termed idiopathic inflammatory bowel disease), acute pancreatitis, canine parvovirus infection, hepatic disease, acute abdomen, and protein-losing enteropathy. The diversity of the assays available to measure CRP in dogs is nearly as numerous as the diseases in which serum concentrations of this protein are increased. Assay methodologies include laser nephelometric immunoassays, enzyme-linked immunosorbent assays, immunoturbidimetric assays, and time-resolved immunofluorometric assays. While many of these assays are acceptable for clinical use in the dog, the same assay and analyzer should be used to measure a patient's CRP concentration longitudinally. By looking at the uses of CRP in human gastroenterology, including reducing the duration of antibiotic therapy, the veterinary profession can gain insight into novel ways in which serum CRP concentration measurements might be applied in veterinary medicine in the future.

Approach to the Diagnosis of Hepatocutaneous Syndrome in Dogs: A Retrospective Study and Literature Review

Superficial necrolytic dermatitis (SND) is a rare and often fatal disease in dogs that has been associated with pancreatic neuroendocrine neoplasia (SND/EN) and hepatocutaneous syndrome (SND/HCS). Although various combinations of diagnostics have been used to differentiate these two causes of SND, there are currently no data on which combination would enable the most timely and noninvasive way to diagnose HCS. Medical records were reviewed retrospectively (2004-2018) for dogs with SND/HCS (n = 24) and SND/EN (n = 1). These data were compared with cases found by review of the literature of dogs with SND/HCS (n = 105) and SND/EN (n = 13). The most consistent findings with SND were dermatological lesions affecting paw pads or mucocutaneous junctions (143/143, 100%) and marked plasma hypoaminoacidemia (58/58, 100%). On ultrasound, a honeycomb liver was seen in 62/63 (98%) dogs with SND/HCS but none with SND/EN. Six out of 23 (26%) dogs in the retrospective study with SND/HCS had marked keratinocyte apoptosis, a finding that was associated with diabetes mellitus. This study suggests that in dogs with characteristic skin lesions, an amino acid profile permits a noninvasive diagnosis of SND. An abdominal ultrasound can then assist in the differentiation of SND/HCS and SND/EN.

Amino Acids in Dog Nutrition and Health

The dog has assumed a prominent role in human society. Associated with that status, diet choices for companion dogs have begun to reflect the personal preferences of the owners, with greater emphasis on specialty diets such as organic, vegan/vegetarian, and omission or inclusion of specific ingredients. Despite consumer preferences and many marketing strategies employed, the diets must ensure nutritional adequacy for the dog; if not, health becomes compromised, sometimes severely. The most frequent consideration of consumers and dog food manufacturers is protein source and concentration with a growing emphasis on amino acid composition and bioavailability. Amino acids in general play diverse and critical roles in the dog, with specific amino acids being essential. This review covers what is known regarding amino acids in dog nutrition.

Extremely high canine C-reactive protein concentrations > 100 mg/l - prevalence, etiology and prognostic significance

BACKGROUND

In human medicine, extremely high CRP (C-reactive protein) concentrations > 100 mg/l are indicators of bacterial infection and the need of antibiotic treatment. Similar decision limits for septic pneumonia are recommended for dogs but have not yet been evaluated for other organ systems. The aim of the retrospective study was to investigate the prevalence and evaluate dogs with CRP concentrations > 100 mg/l regarding the underlying etiology, the affected organ system and the prognostic significance.

RESULTS

Prevalence of CRP > 100 mg/l was investigated in dogs presented between 2014 and 2015 and was 12%. For evaluation of etiology and organ systems, dogs with CRP > 100 mg/l presented between 2014 and 2016 were enrolled. Dogs were classified into 4 main disease categories, i.e. inflammatory, neoplastic, tissue damage or "diverse". Diseases were assigned to the affected organ system. If an organ classification was not possible, dogs were classified as "multiple". 147 dogs with CRP 101-368 mg/l were included and classified into disease categories: 86/147 (59%) with inflammatory etiology (among these, 23/86 non-infectious, 44/86 infectious (33/44 bacterial), 19/86 inflammation non-classifiable), 31/147 (21%) tissue damage, 17/147 (12%) neoplastic (all malignant) and 13/147 (9%) diverse diseases. The affected organ systems included 57/147 (39%) multiple, 30/147 (20%) trauma, 21/147 (14%) gastrointestinal tract, 10/147 (7%) musculoskeletal system, 8/147 (5%) respiratory tract, 7/147 (5%) urinary/reproductive tract, 6/147 (4%) skin/subcutis/ear, 6/147 (4%) central/peripheral nervous system and 2/147 (1%) heart. The disease group (p = 0.081) or organ system (p = 0.17) did not have an impact on CRP. Based on CRP, a detection of bacterial infection was not possible. The prognostic significance was investigated by determining the 3-months survival and hospitalization rate in a subgroup with known outcome. The 3-months survival rate was 46/73 (63%) while the majority 66/73 (90%) of patients was hospitalized.

CONCLUSIONS

CRP concentrations > 100 mg/l are occasionally seen in a clinic population. They indicate a severe systemic disease of various etiologies with guarded prognosis. Extremely high CRP concentrations do not allow a conclusion of the underlying etiology or an identification of bacterial inflammation.

Pilot study on serum C-reactive protein in pet rabbits: clinical usefulness

Objectives

The present study was performed to evaluate the usefulness of serum C-reactive protein (CRP) as an acute phase reactive protein in pet rabbits in clinical practice.

Methods

The CRP level using a rabbit CRP ELISA and white blood cell (WBC) count in pet rabbits (30 healthy controls and 62 with various diseases) were measured in the clinical practice setting. The CRP level and WBC count were measured before and after ovariohysterectomy of a healthy rabbit and a rabbit with uterine adenocarcinoma. The association between the CRP level and mortality in rabbits with various diseases was assessed.

Results

The CRP level in healthy controls was 0.52±0.82 mg/dl (mean±SD). No age and sex-related differences in neither the CRP level nor WBC count were observed in the healthy control rabbits. The CRP levels in rabbits with gastrointestinal disease (n=22, 11.74±22.89 mg/dl), reproductive and urinary system disease (n=20, 21.19±49.68 mg/dl), dental disease (n=6, 4.87±5.47 mg/dl) and musculoskeletal disease (n=4, 85.66±107.28 mg/dl) were significantly higher than those in healthy controls. The CRP levels in rabbits with neurological disease (n=7, 2.55±1.79 mg/dl) and dermatological disease (n=3, 8.84±7.71 mg/dl) were higher than those in healthy controls, but no significant difference was observed. The WBC counts were not significantly different between rabbits with diseases and healthy controls. Serum samples were collected from two rabbits before and after ovariohysterectomy. In both rabbits, the CRP peaked on postoperative day 1, but no obvious WBC peak was observed. The mortality rate increased as the CRP level increased; the mortality rate was significantly higher in rabbits with a CRP level of ≥100 mg/dl than of <10 mg/dl.

Conclusions

This study indicates that the serum CRP level is useful to determine the disease status, monitor the treatment course and evaluate the prognosis in pet rabbits in clinical practice.

Plasma amino acid profiles in dogs with inflammatory bowel disease

BACKGROUND

Lymphocytic-plasmacytic enteritis is the common form of idiopathic inflammatory bowel disease (IBD) in dogs. In human IBD, disturbances of amino acid metabolism have been demonstrated to be involved in the pathophysiology of IBD. Therefore, plasma amino acid profile might represent a novel marker of human IBD.

OBJECTIVES

To determine the plasma amino acid profiles of dogs with IBD and its usefulness as a novel marker of IBD in dogs.

ANIMALS

Fasting blood plasma was obtained from 10 dogs with IBD and 12 healthy dogs.

METHODS

All IBD dogs were prospectively included in this study, and heparinized blood samples were collected. The plasma concentrations of 21 amino acids were determined using the ninhydrin method. The relationships among the plasma amino acid concentrations and plasma C-reactive protein (CRP) concentration, canine chronic enteropathy clinical activity index (CCECAI), and overall World Small Animal Veterinary Association (WSAVA) score were investigated.

RESULTS

Median concentration (nmol/mL) of methionine [46.2; range, 30.0-59.3], proline [119.4; range, 76.7-189.2], serine [115.1; range, 61.4-155.9], and tryptophan [17.4; range, 11.9-56.3]) were significantly lower than in control dogs [62.6; range, 51.0-83.6, 199.1; range, 132.5-376.7, 164.3; range, 124.7-222.9, and 68.3; range, 35.7-94.8, respectively]. A negative correlation was identified between the plasma serine concentration and CCECAI (r _s = -.67, P = .03), but there were no correlations between plasma amino acid concentrations and CRP concentration or overall WSAVA score.

CONCLUSIONS AND CLINICAL IMPORTANCE

Plasma serine concentration might represent a novel maker of IBD in dogs.

Retrospective evaluation of the route and timing of nutrition in dogs with septic peritonitis: 68 cases (2007-2016)

OBJECTIVE

To determine the impact of route of nutrition on length of hospitalization and survival to discharge in dogs with septic peritonitis.

DESIGN

Retrospective study from 2007 to 2016.

SETTING

University teaching hospital.

ANIMALS

Sixty-eight dogs with septic peritonitis that survived ≥48 hours.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Nutritional strategy was categorized into 1 of 4 groups: voluntary, feeding tube, parenteral (PN), and combined feeding tube and PN. Body weight, body condition score, time without caloric intake before and during hospitalization, length of hospitalization, and percentage of resting energy requirements provided during the first 3 days of nutritional support were recorded. Overall, 54/68 dogs survived (79%). Survival Prediction Index 2 scores were not significantly different between groups. Dogs receiving PN only were less likely to survive than those receiving any enteral nutrition (OR 9.7; 95CI 1.84-58.75). Compared to dogs not receiving PN, dogs receiving any PN were significantly less likely to survive (OR 9.66; 95% CI 1.7-105.8), and were in hospital significantly longer (P = 0.025). Metabolic complications associated with PN were frequent but not associated with increased length of hospitalization or survival to discharge.

CONCLUSIONS

Dogs with septic peritonitis that received any PN were in hospital longer and less likely to survive but may have been sicker than those receiving other forms of nutritional support. Further studies are warranted to evaluate reasons for worse outcomes in dogs with septic peritonitis receiving PN.

Plasma citrulline, arginine, nitric oxide, and blood ammonia levels in neonatal calves with acute diarrhea

Background

Plasma citrulline (CIT) concentration is considered to be a reliable marker of functional enterocyte mass, primarily in humans. However, information about CIT levels along with related metabolites, arginine (ARG), nitric oxide (NO), and ammonia in neonatal calves are lacking.

Objectives

To compare plasma CIT, ARG, NO, and whole blood ammonia concentrations in neonatal calves with acute diarrhea with those in healthy calves and to assess their possible relationships with diarrhea‐related criteria.

Animals

Seventy neonatal calves (60 with acute diarrhea and 10 healthy).

Methods

Observational case‐control study. Diarrheic calves were classified into subgroups on the basis of etiology, severity of diarrhea, degree of dehydration, and systemic inflammatory response syndrome (SIRS) status. Plasma CIT and ARG concentrations were measured by liquid chromatography/tandem mass spectrometry.

Results

Plasma CIT (median [range]: 67.5 [61.9‐75.4] vs 30.1 [15.0‐56.1] μmol/L) and ARG (170.7 [148.5‐219.5] vs 106.1 [54.4‐190.7] μmol/L) were lower and plasma NO (4.42 [3.29‐5.58] vs 6.78 [5.29‐8.92] μM) and blood ammonia concentrations (28.7 [26.1‐36.9] vs 59.8 [34.6‐99.5] μmol/L) were higher in the neonatal calves with diarrhea (P < .001). Plasma CIT (β = −0.29, P = .02), ARG (β = −0.33, P = .01), NO (β = 0.55, P < .001), and blood ammonia (β = 0.63, P <.001) were affected by SIRS status. Except for ammonia (0.52), the effects sizes for severity of diarrhea and degree of dehydration were small (ηp2 ≤ 0.45) for CIT, ARG, and NO.

Conclusions and Clinical Importance

The changes in these variables might have diagnostic, prognostic, and therapeutic value in diarrheic neonatal calves.

Effects of isoquinoline alkaloids from Macleaya cordata on physiological, immunological and inflammatory parameters in healthy beagles: Alkaloids in dog nutrition

The aim of the study was to investigate nutritional, physiological and immunological effects of a plant-derived blend of isoquinoline alkaloids (Sangrovit® Extra) in healthy dogs. Two groups of healthy, adult beagles (N = 10) were tested in a cross-over experiment, lasting two consecutive three-week periods. The experimental group received 1.2 g additive/kg feed, according to the recommendation of 10-20 mg/kg live weight per day. The control group received the same feed without additive. Complete blood count, immunological parameters and amino acid concentrations in serum were assessed. Faeces were analysed for short-chain fatty acids, lactate and ammonium; moreover, their quantity and consistency were determined. Neither feed intake, total apparent nutrient digestibility (crude protein and fat, organic matter, sodium, potassium) were affected by intake of the product. Lymphocyte and monocyte counts were slightly increased in both groups. Elevation was not treatment dependant. IgA, IgG, haptoglobin in serum and flow cytometric phenotyping of peripheral lymphocytes were not affected by alkaloids supplementation. Numerically greater methionine concentrations in blood serum occurred in the experimental group (p = 0.182). Quantity and consistency of faeces and ammonium concentration in faeces were not affected by the additive. Faecal concentrations of short-chain organic acids differed between groups (acetic acid, % of total SCFA: control group 52.3 ± 5.2 vs. experimental group 57.1 ± 4.5, p = 0.042), lactate concentrations (d-, l- and total) did not. Due to the shift of SCFA proportions in faeces, an effect of isoquinoline alkaloids (IQs) on the metabolic activity of intestinal microbiota is probable. In conclusion, the addition of IQs in the given dose was well tolerated and did not have adverse effects in healthy dogs.

Clinical utility of currently available biomarkers in inflammatory enteropathies of dogs

Chronic inflammatory enteropathies (CIE) in dogs are a group of disorders that are characterized by chronic persistent or recurrent signs of gastrointestinal disease and histologic evidence of mucosal inflammation. These CIEs are classified as either food-responsive, antibiotic-responsive, or immunosuppressant-responsive enteropathy. Patients not clinically responding to immunomodulatory treatment are grouped as nonresponsive enteropathy and dogs with intestinal protein loss as protein-losing enteropathy. Disease-independent clinical scoring systems were established in dogs for assessment of clinical disease severity and patient monitoring during treatment. Histopathologic and routine clinicopathologic findings are usually not able to distinguish the subgroups of CIE. Treatment trials are often lengthy and further diagnostic tests are usually at least minimally invasive. Biomarkers that can aid in defining the presence of disease, site of origin, severity of the disease process, response to treatment, or a combination of these would be clinically useful in dogs with CIE. This article summarizes the following biomarkers that have been evaluated in dogs with CIE during the last decade, and critically evaluates their potential clinical utility in dogs with CIE: functional biomarkers (cobalamin, methylmalonic acid, folate, α1 -proteinase inhibitor, immunoglobulin A), biochemical biomarkers (C-reactive protein, perinuclear anti-neutrophilic cytoplasmic antibodies, 3-bromotyrosine, N-methylhistamine, calprotectin, S100A12, soluble receptor of advanced glycation end products, cytokines and chemokines, alkaline phosphatase), microbiomic biomarkers (microbiome changes, dysbiosis index), metabolomic biomarkers (serum metabolome), genetic biomarkers (genomic markers, gene expression changes), and cellular biomarkers (regulatory T cells). In addition, important performance criteria of diagnostic tests are briefly reviewed.

Association of pre- and early post-transplant serum amino acids and metabolites of amino acids and liver transplant outcome

The aim of the present study was to investigate association of serum amino (AA) acids and metabolites of AAs with post-transplant outcome in liver transplant recipients. Eighty-nine patients with end-stage liver diseases and available pre- and early post-transplant serum were characterised as patients with (GI) and without one-year mortality (GII) and patients with and without early graft dysfunction (EAD). A panel of pre- and early post-transplant serum levels of AAs and early and metabolites of tryptophan were measured using tandem mass spectrometry. Patient groups had significantly higher pre-transplant serum levels of phenylalanine, tryptophan, and tryptophan metabolites than healthy controls (for all p<0.001). Pre-transplant serum levels of all these parameters were significantly higher in GI than in GII (for all p<0.001). GI had a higher MELD score and re-transplantation number than GII (p≤0.005 for both investigations). Serum bilirubin on day 5 and serum phenylalanine on day 10 post-transplant were associated parameters of mortality, whereas day 1post-transplant phenylalanine and kynurenine and female gender were associated parameters of EAD. Our results indicate that pre- and early post-transplant levels of phenylalanine, tryptophan and metabolites of tryptophan are increased in patients and are associated with EAD and one-year mortality in liver transplant recipients.

Circadian and postprandial variation in plasma citrulline concentration in healthy dogs

OBJECTIVE

To evaluate circadian and postprandial variations in plasma citrulline concentration in healthy dogs.

ANIMALS

8 healthy Beagles.

PROCEDURES

Blood samples were collected from dogs after 12 hours of food withholding (0 hours; 8:00 am) and then every 2 hours for 12 hours (until 8:00 pm) and again at 24 hours (8:00 am the next day). The same protocol was repeated, with the only difference being that a meal was given immediately after the 0-hour sample collection point. Plasma citrulline concentration was measured by ion exchange chromatography.

RESULTS

No significant difference in plasma citrulline concentration was identified among measurement points when food was withheld. Mean ± SD plasma citrulline concentration at 4 hours (72.2 ± 12.7 μmol/L) and 24 hours (56.1 ± 12.5 μmol/L) after dogs were fed was significantly different from that at 0 hours (64.4 ± 12.7 μmol/L).

CONCLUSIONS AND CLINICAL RELEVANCE

Plasma citrulline concentration had no circadian variation in unfed dogs but increased significantly in fed dogs 4 hours after a meal. Therefore, food should be withheld from dogs for 8 to 12 hours before blood sample collection for measurement of citrulline concentration.

Biomarkers for differentiation of causes of respiratory distress in dogs and cats: Part 2--Lower airway, thromboembolic, and inflammatory diseases

OBJECTIVES

To review the current veterinary and relevant human literature regarding biomarkers of respiratory diseases leading to dyspnea and to summarize the availability, feasibility, and practicality of using respiratory biomarkers in the veterinary setting.

DATA SOURCES

Veterinary and human medical literature: original research articles, scientific reviews, consensus statements, and recent textbooks.

HUMAN DATA SYNTHESIS

Numerous biomarkers have been evaluated in people for discriminating respiratory disease processes with varying degrees of success.

VETERINARY DATA SYNTHESIS

Although biomarkers should not dictate clinical decisions in lieu of gold standard diagnostics, their use may be useful in directing care in the stabilization process. Serum immunoglobulins have shown promise as an indicator of asthma in cats. A group of biomarkers has also been evaluated in exhaled breath. Of these, hydrogen peroxide has shown the most potential as a marker of inflammation in asthma and potentially aspiration pneumonia, but methods for measurement are not standardized. D-dimers may be useful in screening for thromboembolic disease in dogs. There are a variety of markers of inflammation and oxidative stress, which are being evaluated for their ability to assess the severity and type of underlying disease process. Of these, amino terminal pro-C-type natriuretic peptide may be the most useful in determining if antibiotic therapy is warranted. Although critically evaluated for their use in respiratory disorders, many of the biomarkers which have been evaluated have been found to be affected by more than one type of respiratory or systemic disease.

CONCLUSION

At this time, there are point-of-care biomarkers that have been shown to reliably differentiate between causes of dyspnea in dogs and cats. Future clinical research is warranted to understand of how various diseases affect the biomarkers and more bedside tests for their utilization.

Application of Pre-Column Labeling Liquid Chromatography for Canine Plasma-Free Amino Acid Analysis

Plasma-free amino acid (PFAA) levels are a useful metric for diagnosing cancer and providing a prognosis. However, the use of analysis of PFAA levels has been limited in the veterinary medicine field. We addressed the application of liquid chromatography (LC) using a pre-column labeling technique for analysis of canine PFAA levels. This method significantly shortened the analysis time relative to conventional methods. No diurnal fluctuations were detected at 9:00 AM in most PFAA levels, and food intake increased the levels of some PFAAs, including valine, leucine, tyrosine, phenylalanine, and proline. These results indicate that LC with pre-column labeling is useful for measuring canine PFAA levels, for which time of day and interval after food intake must be taken into consideration.

Nutritional analysis and microbiological evaluation of commercially available enteral diets for cats

OBJECTIVE

To determine the prevalence of nutrients less than or greater than accepted standards in commercially available enteral diets for cats, and to identify contamination incidence in enteral diets for cats.

DESIGN

Prospective cross-sectional study.

SETTING

University teaching hospital.

SAMPLES

Seven commercial enteral diets for cats.

INTERVENTIONS

Labels were evaluated to determine if diets were intended to be nutritionally complete and balanced. One diet under storage techniques partially representative of clinical conditions was sampled on days 0, 1, 3, 5, and 7 of storage for aerobic bacterial culture.

MEASUREMENTS AND MAIN RESULTS

All 7 diets were analyzed for key nutrients and results were compared to Association of American Feed Control Officials (AAFCO) Nutrient Profiles for Adult Cats for maintenance and National Research Council recommended allowance (NRC-RA). From label information, 4 diets were classified as complete and balanced and 3 diets were classified as not complete and balanced. All 7 diets had at least 1 nutrient less than the AAFCO minimums and the NRC-RA. The total number of nutrients less than AAFCO minimums ranged from 3 to 9 (median = 4), with iron, potassium, and manganese being the most common. Concentrations of some nutrients were undetectable. None of the samples tested had a positive aerobic culture at baseline (day 0) or on subsequent samples from days 1, 3, 5, and 7 under any storage condition.

CONCLUSIONS

None of the diets analyzed met all of the minimum nutrient concentrations. While short-term feeding may not be of concern for an individual patient, clinicians should be aware of potential nutritional limitations when feeding enteral diets to ill or injured cats.

Peri-Surgical Nutrition: Perspectives and Perceptions

Peri-surgical nutrition of veterinary patients is in its infancy, with considerable research to be performed to help improve quality of life in our small animal patients. Clues from human immunonutrition may be starting places for investigation. Considerations for future investigations should include essential nutrients, the underlying disease process, therapeutic goals, and species (dog or cat). There are guidelines for caloric requirements. Planning for nutritional support before surgery takes place is likely to be beneficial to patient outcomes. Taking into account case history, method of feeding, metabolic abnormalities, and possible immunonutrition should be part of a complete surgical nutritional plan.

C-reactive protein and high mobility group box 1 in dogs with gastric dilatation and volvulus

OBJECTIVE

To (1) measure C-reactive protein (CRP) and high mobility group box 1 (HMGB1) and (2) evaluate their prognostic value and relationship to severity of systemic inflammatory response syndrome, routine hematological and acid-base parameters in dogs with gastric dilatation volvulus (GDV).

DESIGN

Prospective observational study from September 2010 to June 2012.

SETTING

Veterinary teaching hospital.

ANIMALS

Forty-one client-owned dogs with GDV.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Blood was collected before surgery (baseline), postsurgery, 6-10 hours postsurgery, and 18-22 hours postsurgery. CRP and HMGB1 were measured in all samples, and routine hematological, biochemical, and acid-base analyses were performed. Only baseline and postsurgery samples were used from nonsurvivors (n = 10). CRP increased significantly from postsurgery sampling to 18-22 hours postsurgery, while HMGB1 did not change over time. There was a significant difference in HMGB1 between survivors and nonsurvivors over time. Both proteins correlated with systemic inflammatory response syndrome severity, total leukocyte, segmented neutrophils, and band counts. HMGB1 correlated also with acid-base parameters (pH, bicarbonate, base excess).

CONCLUSION

HMGB1 and CRP behaved differently in regards to their kinetic patterns, with HMGB1 appearing to better reflect the severity of tissue injury in dogs with GDV than CRP.

Prospective evaluation of the acute patient physiologic and laboratory evaluation score and an extended clinicopathological profile in dogs with systemic inflammatory response syndrome

OBJECTIVE

To investigate the prognostic value of the acute patient physiologic and laboratory evaluation (APPLE) score and relevant clinicopathological markers in dogs with systemic inflammatory response syndrome (SIRS).

DESIGN

Prospective observational cohort study.

SETTING

Veterinary teaching hospital.

ANIMALS

Thirty-three dogs with SIRS admitted to the intensive care unit (ICU) were compared to 35 healthy control dogs. Dogs with SIRS were divided into septic (n = 20) and nonseptic (n = 13) etiologies and as survivors (alive to discharge, n = 22) and nonsurvivors (n = 11: died, n = 6, or humanely euthanized, n = 5).

MEASUREMENTS AND MAIN RESULTS

For all dogs, physiological and laboratory parameters were prospectively collected for the calculation of the APPLE fast score. No difference between septic and nonseptic SIRS dogs was detected for any parameter evaluated. Survivors had significantly higher total protein, albumin concentrations, antithrombin activity (ATA), and base excess (BE), as well as significantly lower lactate, urea, creatinine concentrations, urinary protein to creatinine ratio and APPLE fast score compared to nonsurvivors. Higher values of creatinine, lactate, anion gap, alanine transaminase (ALT), and APPLE fast score were significantly associated with an increased risk of death in SIRS dogs, while higher values of total protein, albumin, ATA, and BE were associated with a significantly reduced risk of mortality. When a multivariate binary logistic regression analysis was performed, the APPLE fast score was the only significant parameter retained.

CONCLUSIONS

The determination of the APPLE fast score in clinical setting, as well as the measurement of APP, ATA, lactate, BE, anion gap, ALT, urinary proteins, and electrolytes may be beneficial for a better assessment of dogs with SIRS. Identified parameters were significantly related with the presence of SIRS and their evaluation should be considered for the assessment of disease severity, and guidance of the decision-making process in critically ill dogs.

Effect of graded inclusion of dietary soybean meal on nutrient digestibility, health, and metabolic indices of adult dogs

Two studies were conducted using adult dogs to evaluate the effect of increasing the inclusion of soybean meal (SBM) in an adult dog food on body composition, hematological and biochemical blood analyses, and total tract nutrient digestibility. Nutritionally complete and balanced diets were formulated with commercial-grade SBM (48% CP) to replace 0, 10, 20, or 30% of the protein provided by dried chicken protein resulting in final SBM inclusion of 0, 6.0, 11.5, and 17.0% (as-fed basis), respectively. In study 1, diets were fed during a 24-wk feeding trial using 36 female (spayed), adult hounds to evaluate food intake, BW, body composition, and blood measurements. There were no diet-related differences in food intake or BW. Body composition responded in a quadratic manner to increased dietary SBM inclusion with the percentage (%) of lean mass responding positively (P < 0.05) and absolute amounts of fat mass and percent body fat responding negatively (P < 0.05). All diagnostic blood components remained within normal physiological ranges for healthy, adult dogs. Serum concentrations of C-reactive protein and IGF-1 were similar among diets. In study 2, diets were evaluated in a digestibility study using 12 adult dogs in a 4 × 4 Latin square design. Increased SBM inclusion was associated with linear increases in the digestibility of CP (P < 0.05) and fat (P < 0.05) and CP retention (P < 0.05). Linear reductions in fecal DM content (P < 0.01) and increased fecal output (P < 0.05) were noted with increased SBM inclusion. All diets were similar in DE and ME content, but a quadratic trend was noted with increased SBM inclusion when DE (P = 0.083) and ME (P = 0.062) were expressed per unit of metabolic body size. Overall, it can be inferred from these results that the partial replacement of dried chicken protein with SBM in a nutritionally complete and balanced diet does not compromise the nutritional status and long-term health of adult dogs.

Effects of carprofen and meloxicam on C-reactive protein, ceruloplasmin, and fibrinogen concentrations in dogs undergoing ovariohysterectomy

OBJECTIVE

To evaluate the effects of perioperative oral administration of carprofen and meloxicam on concentrations of 3 acute-phase proteins in dogs undergoing elective ovariohysterectomy (OVH).

ANIMALS

18 healthy adult anestrous female dogs undergoing elective OVH.

PROCEDURES

Dogs were allocated to 3 groups (6 dogs/group). A placebo treatment, carprofen (2.0 mg/kg), or meloxicam (0.2 mg/kg) was orally administered to the dogs of the respective groups. The initial doses were administered 30 minutes before premedication prior to OVH; additional doses were administered once daily for 4 days after surgery. Blood samples were collected 45 minutes before premedication and 4, 8, 12, 24, 36, 48, 72, 96, and 120 hours after the end of OVH; samples were used for measurement of total WBC and neutrophil counts and concentrations of C-reactive protein (CRP), ceruloplasmin, and fibrinogen.

RESULTS

Values did not differ significantly among groups for WBC and neutrophil counts, serum concentrations of CRP and ceruloplasmin, and plasma concentrations of fibrinogen. Concentrations of all inflammatory markers, except serum ceruloplasmin, increased significantly following OVH, but in a similar manner for each group. No significant changes were detected in serum ceruloplasmin concentrations over time.

CONCLUSIONS AND CLINICAL RELEVANCE

Perioperative administration of both carprofen and meloxicam did not significantly affect the concentrations of CRP, ceruloplasmin, and fibrinogen in dogs undergoing OVH. Thus, use of carprofen or meloxicam should not affect clinical interpretation of results for these 3 acute-phase proteins.

Serum biomarkers of clinical and cytologic response in dogs with idiopathic immune-mediated polyarthropathy

Background

Immune‐mediated polyarthopathy (IMPA) is common in dogs, and is monitored by serial arthrocenteses.

Hypothesis/Objectives

Plasma C‐reactive protein (CRP), interleukin‐6 (IL‐6), and CXCL8 (interleukin‐8) would serve as noninvasive markers of joint inflammation in IMPA.

Animals

Nine client‐owned dogs with idiopathic IMPA; 6 healthy controls.

Methods

Prospective study. Plasma CRP, IL‐6, and CXCL8 were measured by ELISA at baseline, 2, and 4 weeks during treatment with prednisone at 50 mg/m²/day. Arthrocenteses, the canine brief pain inventory (CBPI), and accelerometry collars were used to assess joint inflammation, lameness, and mobility at all 3 time points.

Results

C‐reactive protein concentrations were higher in IMPA dogs (median 91.1 μg/mL, range 76.7–195.0) compared with controls (median <6.3 μg/mL, <6.3–13.7; P = .0035), and were significantly lower at week 2 (10.6 μg/mL, <6.3–48.8) and week 4 (<6.3 μg/mL, <6.3–24.4; P < .001).

C‐reactive protein was correlated with median CBPI scores (r = 0.68; P = .0004), joint cellularity (r = 0.49, P = .011), and mobility by accelerometry (r = −0.42, P = .048). Plasma IL‐6 concentrations were also higher in IMPA dogs (median 45.9 pg/mL), compared with controls (median <15.7 pg/mL; P = .0008). IL‐6 was lower in IMPA dogs by week 4 (<15.7 pg/mL; P = .0099), and was modestly correlated with CBPI scores (r = 0.47, P = .023). CXCL8 did not differ significantly between IMPA and healthy dogs.

Conclusions

Plasma CRP and IL‐6 might be useful surrogate markers of synovial inflammation and disease activity in dogs with IMPA.

Nutritional management of acute pancreatitis in dogs and cats

OBJECTIVE

To review current and emerging nutritional approaches in the management of acute pancreatitis (AP) in people, dogs, and cats, and to provide a framework for further investigation in this field.

DATA SOURCES

Veterinary retrospective studies and reviews, human prospective clinical trials and reviews, and experimental animal studies focusing on nutritional management during AP.

SUMMARY

Nutritional management is an important part of the treatment plan for patients with AP. In human medicine, the general approach for providing nutrition in patients with AP has changed in recent years and favors enteral over parenteral nutrition with an emphasis on early enteral nutrition (EN). Although there are limited data available, there is increasing evidence in the veterinary literature that supports the beneficial role of EN in AP and contradicts previous assumptions about poor tolerance to enteral feeding in this patient population. Parenteral nutrition may be appropriate alone or in combination with EN as a temporary measure in malnourished patients that do not tolerate adequate EN; however, enteral feeding should be attempted first in most cases. Immunonutrition is being investigated for its positive role in modulating pancreatic inflammation and improving gut barrier function in cases of human AP.

CONCLUSIONS

The nutritional management of veterinary patients with AP remains challenging. Based on clinical evidence in people, experimental animal studies, and preliminary studies in dogs and cats, the choice of EN over parenteral nutritional support during AP in dogs and cats appears to be beneficial and well tolerated. Optimization of nutritional therapies in dogs and cats including the use of immunonutrition during AP warrants further investigation.

Homocysteine in dogs with systemic inflammatory response syndrome

OBJECTIVES

To compare serum concentrations of homocysteine in healthy dogs and those fitting the criteria for systemic inflammatory response syndrome and to compare these values to commonly measured B-vitamins.

METHODS

Study dogs were classified into non-infectious systemic inflammatory response syndrome or sepsis groups and blood was drawn on Day 1 of the patient's hospitalisation for measurement of serum homocysteine, folate and cobalamin concentrations. Homocysteine concentration was measured in 51 clinically healthy dogs to serve as the control group.

RESULTS

A statistically significant difference was found between the homocysteine concentrations of the healthy group when compared to non-infectious systemic inflammatory response syndrome and sepsis groups. Homocysteine values were not correlated with folate, cobalamin or APPLEfast severity scores. Homocysteine concentrations were significantly lower in sick dogs when compared to the control group, which is dissimilar to the human population.

CLINICAL SIGNIFICANCE

The clinical significance of homocysteine changes in critically ill dogs is currently unknown.

Review of commonly used clinical pathology parameters for general gastrointestinal disease with emphasis on small animals

A wide variety of markers are available to assess the function and pathology of the gastrointestinal (GI) tract. This review describes some of these markers with special emphasis given to markers used in dogs and cats. Small intestinal disease can be confirmed and localized by the measurement of serum concentrations of folate and cobalamin. Fecal α1-proteinase inhibitor concentration can increase in individuals with excessive GI protein loss. A wide variety of inflammatory markers are available for a variety of species that can be used to assess the inflammatory activity of various types of inflammatory cells in the GI tract, although most of these markers assess neutrophilic inflammation, such as neutrophil elastase, calprotectin, or S100A12. N-methylhistamine can serve as a marker of mast cell infiltration. Markers for lymphocytic or eosinophilic inflammation are currently under investigation. Exocrine pancreatic function can be assessed by measurement of serum concentrations of pancreatic lipase immunoreactivity (PLI) and trypsin-like immunoreactivity (TLI). Serum PLI concentration is increased in individuals with pancreatitis and has been shown to be highly specific for exocrine pancreatic function and sensitive for pancreatitis. Serum TLI concentration is severely decreased in individuals with exocrine pancreatic insufficiency.

Is there a correlation between circulating levels of citrulline and intestinal dysfunction in the critically ill?

OBJECTIVE

The aim of this study was to assess the correlation between plasma citrulline and Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, survival, inflammation (C-reactive protein [CRP]), inotrope use, serum levels of prealbumin and albumin, and renal failure in the critically ill patient.

METHODS

This prospective observational single-center controlled study included 91 adult patients over a 2-year period. Inclusion criteria were patients staying in the intensive care unit for >48 hours. Patients' renal status was categorized as those with a glomerular filtration rate (GFR) >60 mL/min without renal support, a GFR >60 mL/min with renal support, a GFR <60 mL/min without renal support, and a GFR <60 mL/min with renal support. Plasma citrulline concentrations were categorized into 3 groups: low (0-15 µmol/L), medium (16-35 µmol/L), and high (>36 µmol/L). The relationship between the recorded parameters and these different cut-off values of plasma citrulline concentrations was analyzed.

RESULTS

Ninety-one patients (34% female and 66% male) with a mean (SD) age of 69.3 (11.9) years, a mean (SD) body mass index of 24.8 (5.34) kg/m(2), a mean (SD) APACHE II score of 22.4 (7.92), a mean (SD) SOFA score of 8 (4.4), and a mean (SD) plasma citrulline of 21.7 (13.1) µmol/L were enrolled. Only patients with intestinal dysfunction had low plasma citrulline level <15 µmol/L (P = .014). No correlations between serum levels of CRP, albumin, or prealbumin; renal failure; inotrope use; SOFA score; and APACHE II score were found with plasma citrulline level.

CONCLUSION

Low plasma citrulline levels in patients correlate well with intestinal dysfunction.

Serum pepsinogen-A, canine pancreatic lipase immunoreactivity, and C-reactive protein as prognostic markers in dogs with gastric dilatation-volvulus

BACKGROUND

Pepsinogens are proenzymes secreted by gastric chief cells. In humans, their serum concentrations reflect gastric mucosal morphological and functional status.

OBJECTIVES

To evaluate serum canine pepsinogen-A (cPG-A), C-reactive protein (CRP), and canine pancreatic lipase immunoreactivity (cPLI) concentrations in dogs with gastric dilatation-volvulus (GDV).

ANIMALS

Sixty-six dogs presented with GDV and 79 healthy controls.

METHODS

Blood was collected prospectively, and records retrospectively reviewed.

RESULTS

Median cPG-A concentration was higher in GDV dogs (median, 397 μg/L; range, 37-5,410) compared to controls (median, cPG-A 304 μg/L; range, 18-848; P = .07). Mortality rate in GDV dogs was 22.7%. In nonsurvivors of GDV, median cPG-A was higher compared to survivors (median, 746 μg/L; range, 128-5,409 versus median, 346; range, 36-1,575, respectively; P = .003). The proportion of dogs with increased cPG-A increased with gastric wall damage score (P = .007). An ROC analysis of cPG-A as a predictor of death showed an area under the curve (AUC) of 0.75, higher than lactate (AUC 0.66), and corresponded to a sensitivity and specificity of 53% and 88%, respectively. CRP was increased in 48 dogs (75%), cPLI was >200 μg/L in 26 dogs (39.4%) and >400 μg/L in 12 dogs (18.2%) but both analytes had no association with outcome.

CONCLUSIONS

Presurgical cPG-A concentration was positively and significantly associated with gastric wall lesion severity, but, based on ROC analysis, it was only a moderate outcome predictor. CRP and cPLI were commonly increased in dogs with GDV.

The immunopathology of sepsis: pathogen recognition, systemic inflammation, the compensatory anti-inflammatory response, and regulatory T cells

Sepsis, the systemic inflammatory response to infection, represents the major cause of death in critically ill veterinary patients. Whereas important advances in our understanding of the pathophysiology of this syndrome have been made, much remains to be elucidated. There is general agreement on the key interaction between pathogen‐associated molecular patterns and cells of the innate immune system, and the amplification of the host response generated by pro‐inflammatory cytokines. More recently, the concept of immunoparalysis in sepsis has also been advanced, together with an increasing recognition of the interplay between regulatory T cells and the innate immune response. However, the heterogeneous nature of this syndrome and the difficulty of modeling it in vitro or in vivo has both frustrated the advancement of new therapies and emphasized the continuing importance of patient‐based clinical research in this area of human and veterinary medicine.

Acute phase proteins in animals

Acute phase proteins (APP) were first identified in the early 1900s as early reactants to infectious disease. They are now understood to be an integral part of the acute phase response (APR) which is the cornerstone of innate immunity. APP have been shown to be valuable biomarkers as increases can occur with inflammation, infection, neoplasia, stress, and trauma. All animals--from fish to mammals--have demonstrable APP, but the type of major APP differs by species. While the primary application of these proteins in a clinical setting is prognostication, studies in animals have demonstrated relevance to diagnosis and detection and monitoring for subclinical disease. APP have been well documented in laboratory, companion, and large animals. With the advent of standardized and automated assays, these biomarkers are available for use in all fields of veterinary medicine as well as basic and clinical research.

Strong association of phenylalanine and tryptophan metabolites with activated cytomegalovirus infection in kidney transplant recipients

Infection-induced inflammation triggers catabolism of proteins and amino acids. Phenylalanine and tryptophan are 2 amino acids related to infections that regulate immune responses. Polyomavirus BK (BKV) and cytomegalovirus (CMV) are important pathogens after kidney transplantation. We investigated the clinical relevance of phenylalanine, tryptophan, and tryptophan metabolites (kynurenine and quinolinic acid) plasma levels in kidney transplant recipients with active CMV (BKV(-)CMV(+), n = 12) or BK virus infection (BKV(+)CMV(-), n = 37). Recipients without active viral infections (CMV(-)BKV(-), n = 28) and CMV(-)BKV(-) healthy individuals (HCs, n = 50) served as controls. In contrast to BKV infection, activated CMV infection is tightly linked to increased phenylalanine and tryptophan metabolite plasma levels (p ≤ 0.002). The association of phenylalanine (cutoff 50 μmol/L) with CMV infection demonstrates high sensitivity (100%) and specificity (94%). By contrast, kynurenine (p = 0.029) and quinolinic acid (p = 0.003) values reflect the severity of CMV infection. In this early proof-of-concept trial, evidence indicates that activated CMV infection is strongly associated with increased phenylalanine as well as kynurenine and quinolinic acid plasma levels. Moreover, tryptophan metabolite levels correlate with disease severity. Measurement of these amino acids is an inexpensive and fast method expected to complete conventional diagnostic assays.

C-reactive protein concentrations in serum of dogs with naturally occurring renal disease

The current study was undertaken to investigate the relation between serum C-reactive protein (CRP) concentrations and parameters of renal function in dogs with naturally occurring renal disease. Dogs were assigned to groups according to plasma creatinine concentration, urinary protein-to-creatinine ratio (UP/UC), and exogenous plasma creatinine clearance (P-ClCr) rates. Group A (healthy control dogs; n = 8): non-azotemic (plasma creatinine <125 µmol/l) and nonproteinuric (UP/UC <0.2), with P-ClCr rates >90 ml/min/m2; group B (n = 11): non-azotemic, nonproteinuric dogs with reduced P-ClCr rates (50–89 ml/min/m2); group C (n = 7): azotemic, borderline proteinuric dogs (P-ClCr rates: 22–67 ml/min/m2); and group D (n = 6): uremic, proteinuric dogs (not tested for P-ClCr). The serum CRP concentrations were measured via commercial enzyme-linked immunosorbent assay. The CRP concentrations in the clinically healthy dogs (group A) ranged from 2.09 mg/l to 8.60 mg/l (median: 3.21 mg/l). In comparison with dogs of group A, median CRP concentrations were significantly ( P < 0.01) elevated in dogs of group B (17.6 mg/l, range: 17.0–19.2 mg/l), group C (24.8 mg/l, range: 18.0–32.5 mg/l), and group D (59.7 mg/l, range: 17.7–123 mg/l). Serum CRP was significantly related to P-ClCr ( r = –0.83; P < 0.001), plasma creatinine ( r = 0.81; P < 0.001), UP/UC ( r = 0.70; P < 0.001), and leukocytes ( r = 0.49; P < 0.01). The significant relations between serum CRP concentrations and biochemical parameters of kidney function in plasma and urine suggest that a stimulation of the acute phase response is implicated in the pathogenesis of canine renal disease.

Associations among albuminuria, C-reactive protein concentrations, survival predictor index scores, and survival in 78 critically ill dogs

BACKGROUND

Microalbuminuria and C-reactive protein (CRP) are predictors of morbidity and survival in critically ill human patients.

HYPOTHESIS/OBJECTIVES

To evaluate results of microalbuminuria assays (untimed single-sample urine albumin concentration [U-ALB] and the urine albumin:creatinine ratio [UACR]), serum CRP, and survival predictor index (SPI2) scores as predictors of survival in critically ill dogs.

ANIMALS

Seventy-eight dogs admitted to intensive care units at University of Tennessee (UT) and Colorado State University (CSU).

METHODS

Prospective observational study. Critically ill dogs were eligible for enrollment, unless euthanized because of financial constraints. Samples were collected within 3 hours of admission. Spearman's rank-correlation coefficients were determined for U-ALB, UACR, CRP, and SPI2. U-ALB, UACR, CRP, and SPI2 were assessed for associations with 7- and 30-day survival by Mann-Whitney U-tests and receiver operating characteristic (ROC) curves. P-values < .0125 were considered significant.

RESULTS

UT (n = 49) and CSU (n = 29) patients did not differ significantly. Forty percent (31/78) of dogs died. SPI2 was inversely correlated with U-ALB (r(s) = -0.39, P < .001) and UACR (r(s) = -0.41, P < .001). CRP was not correlated with SPI2 (P = .019), U-ALB (P > .1), or UACR (P > .1). U-ALB and UACR had very high correlation (r(s) = 0.95, P < .001). SPI2, U-ALB, and UACR differed significantly for survivors and nonsurvivors. SPI2, U-ALB, and UACR had areas under the ROC curve (AUC) from 0.68 to 0.74 for survival prediction.

CONCLUSIONS AND CLINICAL IMPORTANCE

Albuminuria and SPI2, but not CRP, are associated with survival in critically ill dogs. Suboptimal AUCs limit the value of microalbuminuria testing for clinical risk assessment. Additional studies are necessary to determine the usefulness of microalbuminuria testing in patient risk stratification for prospective research.

Assay validation and diagnostic applications of major acute-phase protein testing in companion animals

The use of major acute-phase proteins (APPs) for assessment of health and disease in companion animals has increased within the last decade because of increased knowledge in the field and increased access to appropriate assay systems for detection of relevant APPs, which are highly species specific. Despite evidence being restricted almost solely to proven excellent overlap performance of these markers in detecting inflammatory activity, clinically relevant studies at higher evidence levels do exist. The available body of literature shows a clear, but seemingly untapped, potential for more extended routine clinical use of major APP testing in companion animal medicine.

Evaluation of three automated human immunoturbidimetric assays for the detection of C-reactive protein in dogs

C-reactive protein (CRP) is a major, acute-phase protein in dogs; however, there is a need for automated assays to ensure in-time patient monitoring. Three automated immunoturbidimetric assays (Randox, Thermo, and Wako) developed for human beings were evaluated for their ability to detect canine CRP, including method validation, evaluation of diagnostic use, and establishment of exploratory reference intervals. Sera from 36 healthy dogs and 82 diseased dogs were included for method comparison with the enzyme-linked immunosorbent assay (ELISA; Tridelta) serving as the reference method. A nonparametric estimate of the 1-sided 95% reference interval was established (n = 36). Precision study revealed good intra-assay coefficients of variation (CVs) of 1-10%, 0-9%, and 2-13% for the Randox, Thermo, and Wako assays, respectively. Interassay CVs were 18%, 24%, and 19% respectively. Because of a low linear range, the Thermo test was considered unsuitable for use with canine specimens. No significant differences were present between the results obtained with the Randox and Wako assays with CRP concentrations less than 15 mg/l; however, median CRP results differed significantly between the Thermo test and the ELISA (P = 0.03). Bland-Altman analysis detected a proportional bias of 0.28, -0.59, and 0.61 mg/l for the Randox, Thermo, and Wako assays, respectively. For all tests, median CRP values were significantly different between healthy dogs and dogs with neoplasia. The upper limit of the reference intervals were 8.2 and 9.9 mg/l for the Randox and Wako assays, respectively. In contrast to the Thermo test, the Randox and Wako assays were suitable for detection of abnormally high canine CRP concentrations; however, improvement of assay precision and evaluation of accuracy are warranted before their clinical use with canine specimens.