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

A comparison of the Sepsis-2 and Sepsis-3 definitions for assessment of mortality risk in dogs with parvovirus

OBJECTIVE

To evaluate the use of a modified Sepsis-3 (mSepsis-3) definition compared to the currently used modified Sepsis-2 (mSepsis-2) definition to determine whether the mSepsis-2 or mSepsis-3 stratifications were able to identify populations of dogs ultimately more likely to die from canine parvovirus (CPV) infection.

DESIGN

Retrospective, January 2009 to March 2020.

SETTING

A private, small animal, urban, referral emergency and specialty hospital.

ANIMALS

Fifty-nine client-owned dogs hospitalized for treatment of CPV.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Dogs were divided into mSepsis-2 and mSepsis-3 categories based on the highest level of illness severity reached during hospitalization. Greater illness severity based on mSepsis-2 criteria (ie, sepsis, severe sepsis, septic shock) was associated with an increase in average length of stay (P < 0.001), increase in average cost of stay (P < 0.01), and presence of leukopenia (P < 0.05). An increase in illness severity within the mSepsis-2 criteria was not associated with hyperlactatemia (P = 0.29), presence of neutropenia (P = 0.12), or mortality (P = 0.35). Greater illness severity based on mSepsis-3 criteria (ie, infection only, sepsis, septic shock) was associated with an increase in mortality (P < 0.05), increase in average length of stay (P < 0.001), increase in average cost of stay (P < 0.01), presence of leukopenia (P < 0.01), and presence of neutropenia (P < 0.05). The mSepsis-3 criteria were not associated with the presence of hyperlactatemia (P = 0.68). There was no significant difference between survivors and nonsurvivors in the presence of leukopenia (P = 0.19), neutropenia (P = 0.67), or hyperlactatemia (P = 0.58).

CONCLUSIONS

The mSepsis-3 diagnostic criteria appear to better identify dogs with CPV at higher risk for mortality compared to the mSepsis-2 criteria.

Isolation of Oral Bacteria, Measurement of the C-Reactive Protein, and Blood Clinical Parameters in Dogs with Oral Tumor

Canine oral cancers have a poor prognosis and are related to chronic inflammation. This may pose a risk of secondary bacterial infection. This study aimed to compare the bacteria isolated from oral swab samples, values of C-reactive proteins (CRPs), and clinical blood profiles of dogs with and without oral mass. A total of 36 dogs were divided in three groups: no oral mass (n = 21), oral mass (n = 8), and metastasis groups (n = 7). Significantly, both the clinical groups (the oral mass group and metastasis group) showed anemia, a decrease in the albumin-to-globulin ratio (AGR), and an increase in the neutrophil-to-lymphocyte ratio (NLR), globulin-to-albumin ratio (GAR), CRP, and CRP-to-albumin ratio (CAR) compared to the normal group. CAR showed an increasing trend in the oral mass and metastasis groups (10 times and 100 times, respectively) compared to the no oral mass group (P < 0.001). Neisseria spp. (20.78%) was the main isolated bacteria in all groups. The main genera in the no oral mass group were Neisseria spp. (28.26%), Pasteurella spp. (19.57%), and Staphylococcus spp. (19.57%). Neisseria spp., Staphylococcus spp., Klebsiella spp., and Escherichia spp. were found equally (12.5%) in the oral mass group. Escherichia spp. (26.67%), Pseudomonas spp. (13.33%), and Staphylococcus spp. (13.33%) were the main genera in the metastasis group. Interestingly, Neisseria spp. decreased in the clinical groups (Fisher's exact = 6.39, P=0.048), and Escherichia spp. increased in the metastasis group (Fisher's exact = 14.00, P=0.002). The difference of oral bacteria in clinical dogs compared to healthy dogs may be related to microbiome alterations, and both the clinical groups showed the increment of inflammatory biomarkers. This suggested that further studies should be conducted on the correlation between the specific bacteria, CRP, blood clinical parameters, and type of canine oral mass.

Establishment of a reference interval for urinary albumin-to-creatinine ratio in dogs

BACKGROUND

Albuminuria is an important marker of renal damage and can precede proteinuria; thus, it can be a useful analyte in the early diagnosis of kidney diseases. Albuminuria has also been found in dogs with hypertension, inflammatory, infectious, and neoplastic diseases.

OBJECTIVES

The aim of this study was to establish a reference interval (RI) for albuminuria in dogs.

METHODS

One hundred sixty-four clinically healthy dogs were enrolled in the study. Urinary albumin was determined by the immunoturbidimetric method, and albumin excretion was expressed as the urinary albumin-to-creatinine (UAC) ratio. The RI for UAC was established.

RESULTS

After exclusions, 124 dogs from 32 breeds remained. The median UAC of the study population was 3.0 mg/g (range: 0-48). The RI was defined as 0-19 mg/g (with a 90% CI for the upper limit of 13-28 mg/g). No significant difference was found between male and female dogs or between different age and body weight groups. The results of Sighthounds (n = 30) and Beagle dogs (n = 23) did not differ from the other breeds.

CONCLUSION

The canine RI of UAC is similar but somewhat narrower than the human RI.

Restrained expression of canine glucocorticoid receptor splice variants α and P prognosticates fatal disease outcome in SIRS

Glucocorticoids play a central role in the inflammatory response and alleviate the symptoms in critically ill patients. The glucocorticoid action relies on the glucocorticoid receptor (GR) which translocates into the nucleus upon ligand-binding and regulates transcription of a battery of genes. Although the GR is encoded by a single gene, dozens of its splice variants have been described in diverse species. The GRα isoform encodes the full, functionally active protein that is composed of a transactivation, a DNA-binding, and a C-terminal ligand-binding domain. The second most highly expressed receptor variant, the GR-P, is formed by an intron retention that introduces an early stop codon and results in a probably dysfunctional protein with truncated ligand-binding domain. We described the canine ortholog of GR-P and showed that this splice variant is highly abundant in the peripheral blood of dogs. The level of cGRα and cGR-P transcripts are elevated in patients of SIRS and the survival rate is increased with elevated cGRα and cGR-P expression. The ratio of cGRα and cGR-P mRNA did not differ between the survivor and non-survivor patients; thus, the total GR expression is more pertinent than the relative expression of GR isoforms in assessment of the disease outcome.

Evaluation of the progression of non-azotemic proteinuric chronic kidney disease in dogs

Proteinuria is a recognized risk factor for progression of canine chronic kidney disease (CKD). However, the prognosis of non-azotemic proteinuric CKD in dogs has been studied only to a limited extent. Moreover, the degree to which proteinuria should be decreased to delay CKD progression remains unknown. The purposes of this study were (1) to identify factors associated with disease progression and (2) to investigate the degree of proteinuria, albuminuria, and blood pressure during the course of treatment associated with the progression using time-averaged urine protein:creatinine ratio (UPC) and urine albumin:creatinine ratio (UAC) in canine non-azotemic proteinuric CKD. Twenty-one dogs with non-azotemic proteinuric CKD were included in the study. High UPC and UAC were associated with CKD progression (P < .05). Time-averaged high UPC and UAC were significantly related to progression (P < .05). The cutoff values of these time-averaged parameters for predicting the progression were 4.1 and 2.0, respectively. In dogs with non-azotemic proteinuric CKD, more severe proteinuria and albuminuria were associated with progression. The present study suggests that because UPC ≥ 4.1 and UAC ≥ 2.0 during treatment were associated with a faster progression of non-azotemic proteinuric CKD, therapeutic intervention is warranted.

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.

Urinary proteome and metabolome in dogs (Canis lupus familiaris): The effect of chronic kidney disease

Chronic kidney disease (CKD) is a progressive and irreversible disease. Although urine is an ideal biological sample for proteomics and metabolomics studies, sensitive and specific biomarkers are currently lacking in dogs. This study characterised dog urine proteome and metabolome aiming to identify and possibly quantify putative biomarkers of CKD in dogs. Twenty-two healthy dogs and 28 dogs with spontaneous CKD were selected and urine samples were collected. Urinary proteome was separated by SDS-PAGE and analysed by mass spectrometry, while urinary metabolome was analysed in protein-depleted samples by 1D ¹H NMR spectra. The most abundant proteins in urine samples from healthy dogs were uromodulin, albumin and, in entire male dogs, arginine esterase. In urine samples from CKD dogs, the concentrations of uromodulin and albumin were significantly lower and higher, respectively, than in healthy dogs. In addition, these samples were characterised by a more complex protein pattern indicating mixed glomerular (protein bands ≥65 kDa) and tubular (protein bands <65 kDa) proteinuria. Urine spectra acquired by NMR allowed the identification of 86 metabolites in healthy dogs, belonging to 49 different pathways mainly involved in amino acid metabolism, purine and aminoacyl-tRNA biosynthesis or tricarboxylic acid cycle. Seventeen metabolites showed significantly different concentrations when comparing healthy and CKD dogs. In particular, carnosine, trigonelline, and cis-aconitate, might be suggested as putative biomarkers of CKD in dogs. SIGNIFICANCE: Urine is an ideal biological sample, however few proteomics and metabolomics studies investigated this fluid in dogs and in the context of CKD (chronic kidney disease). In this research, applying a multi-omics approach, new insights were gained regarding the molecular changes triggered by this disease in canine urinary proteome and metabolome. In particular, the involvement of the tubular component was highlighted, suggesting uromodulin, trigonelline and carnosine as possible biomarkers of CKD in dogs.

A retrospective study of vector-borne disease prevalence in dogs with proteinuria: Southeastern United States

Background

Proteinuria is a risk factor for progressive kidney injury in dogs. Enhanced understanding of potential associations between canine vector‐borne diseases (CVBD) and proteinuria is needed.

Objectives

To determine the proportion of evaluated proteinuric dogs exposed to ≥1 CVBD, including Babesia spp., Ehrlichia spp., spotted‐fever group Rickettsia, Bartonella spp., Anaplasma spp., hemotropic Mycoplasma spp., Borrelia burgdorferi, and Dirofilaria immitis, and to determine if demographic or clinicopathologic differences exist between proteinuric dogs exposed to CVBD versus proteinuric dogs with no evidence of CVBD exposure.

Animals

Two‐hundred nine proteinuric dogs, concurrently tested for CVBD, which were examined at a single academic veterinary hospital between January 2008 and December 2015.

Methods

Retrospective cross‐sectional study. Demographic, clinicopathologic, and CVBD test results were extracted from medical records. A multivariable logistic regression model was used to assess associations between CVBD and selected variables.

Results

Based on serology and polymerase chain reaction testing, 34% of proteinuric dogs (72/209) were exposed to ≥1 CVBD. Exposure to Rickettsia spp. (19%), Ehrlichia spp. (12%), and B. burgdorferi (9%) were most common. The CVBD exposure was lower in dogs tested in autumn or spring, higher in intact dogs, and higher in dogs with lower serum albumin and higher serum creatinine concentrations.

Conclusions and Clinical Importance

Exposure to CVBD, particularly exposure to Rickettsia spp., Ehrlichia spp., and B. burgdorferi was found in proteinuric dogs from the southeast United States. Additional controlled prospective studies examining a potential causal relationship between CVBD and proteinuria are warranted.

The prognostic value of microalbuminuria in puppies with canine parvoviral enteritis

Increased urine albumin concentration (UALB) or urine albumin-to-creatinine ratio (UACR) at admission has been associated with systemic disease and increased morbidity and mortality in critically ill canine patients. The objective of this study was to assess the prognostic value of UALB and UACR for the survival, as well as for the development and duration of systemic inflammatory response syndrome (SIRS) in puppies with canine parvoviral enteritis (CPVE). Unvaccinated puppies, aged 1-12 months with confirmed CPVE, hospitalized for ≥5 days were included. Urine was collected at admission via cystocentesis; albumin was measured immunoturbidimetrically and creatinine spectrophotometrically. The presence of SIRS was daily evaluated. Statistical analysis was conducted using R language. Twenty-six dogs were enrolled; 12/26 (46%) developed SIRS during hospitalization, while 5/26 (19%) died. A significant correlation was found between UALB and UACR (ϱ=0.868, p<0.001). The dogs with SIRS had higher median UALB [0.5 (0-12.7) mg/dL] and UACR [4.2 (0-2,093) mg/g] compared to dogs without SIRS [UALB= 0.1 (0-0.8) mg/dL, UACR= 1.6 (0-5.6) mg/g], but the differences were non-significant (p>0.05). SIRS duration was significantly correlated with UACR (ϱ=0.427, p=0.030), but not with UALB (ϱ=0.386, p=0.052). The non-survivors had higher median UALB [0.6 (0.1-12.7) mg/dL] and UACR [19.6 (0.7-2,093) mg/g] compared to survivors [UALB= 0.2 (0-1.5) mg/dL, UACR= 2.3 (0-16.9) mg/g], but the differences were non-significant (p>0.05). UACR appears to be a prognostic indicator of SIRS duration in puppies with CPVE. However, a large-scale study is warranted to confirm the usefulness of UALB and UACR for clinical risk assessment in puppies with CPVE.

A pilot study evaluating the prognostic utility of platelet indices in dogs with septic peritonitis

OBJECTIVE

To characterize platelet indices at time of diagnosis of septic peritonitis in dogs and to assess the relationship between platelet parameter data and survival to discharge in dogs treated surgically.

DESIGN

Retrospective, observational, descriptive pilot study from 2009 to 2014.

SETTING

University teaching hospital.

ANIMALS

Forty-eight dogs diagnosed with septic peritonitis were included in this study. Thirty-six dogs had surgical source control. Blood samples from 46 healthy control dogs were used for reference interval (RI) generation.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Dogs with septic peritonitis had significantly increased mean values for mean platelet volume (MPV), plateletcrit (PCT), and platelet distribution width (PDW) with increased proportions of dogs having values above the RI compared to healthy dogs. A significantly increased proportion of dogs with septic peritonitis had platelet counts above (12.5%) and below (8.3%) the RI, with no significant difference in mean platelet count compared to healthy dogs. No significant differences in the mean platelet count, MPV, PCT, or PDW were found between survivors and nonsurvivors in dogs with surgical source control; however, dogs with MPV values above the RI had significantly increased mortality compared to dogs within the RI (P = 0.025). Values outside the RI for other platelet parameters were not associated with significant differences in mortality.

CONCLUSIONS

Dogs with septic peritonitis have increased frequency of thrombocytosis and thrombocytopenia with increased MPV, PCT, and PDW. An increased MPV may be a useful indicator of increased risk of mortality in dogs treated surgically.

Validation of an electrophoretic method to detect albuminuria in cats

Objectives The aims of this study were to validate a semi-automated high-resolution electrophoretic technique to quantify urinary albumin in healthy and diseased cats, and to evaluate its diagnostic performance in cases of proteinuria and renal diseases. Methods Urine samples were collected from 88 cats (healthy; chronic kidney disease [CKD]; lower urinary tract disease [LUTD]; non-urinary tract diseases [OTHER]). Urine samples were routinely analysed and high-resolution electrophoresis (HRE) was performed. Within-assay and between-assay variability, linearity, accuracy, recovery and the lowest detectable and quantifiable bands were calculated. Receiver operating curve (ROC) analysis was also performed. Results All coefficients of variation were <10%, percentage recovery was between 97% and 109% with a high linearity (r = 0.99). HRE allowed the visualisation of a faint band of albumin and a diffused band between alpha and beta zones in healthy cats, while profiles from diseased cats were variable. Albumin (mg/dl) and urine albumin:creatinine ratio (UAC) were significantly ( P <0.05) different between healthy and diseased cats. After ROC analysis, UAC values of 0.035 and 0.074 had a high sensitivity and high specificity, respectively, to classify proteinuria and identify borderline proteinuric cats. Moreover, a UAC of 0.017 had a high sensitivity in distinguishing between healthy and diseased cats. However, UAC was not able to distinguish between renal (CKD) and non-renal diseases (LUTD/OTHER), probably owing to the pathophysiology of CKD in cats, which is characterised by low-grade proteinuria and less glomerular involvement than in dogs. Conclusions and relevance HRE is an accurate and precise method that could be used to measure albuminuria in cats. UAC was useful to correctly classify proteinuria and to discriminate between healthy and diseased cats. HRE might also provide additional information on urine proteins with a profile of all proteins (albumin and globulins) to aid clinicians in the diagnosis of diseases characterised by proteinuria.

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.

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.

A novel severity scoring system for dogs with heatstroke

OBJECTIVE

To develop a statistically-derived scoring system that can aid in severity assessment and outcome prediction for dogs with heatstroke.

DESIGN

Retrospective study.

SETTING

Veterinary teaching hospital.

ANIMALS

One hundred twenty-six client-owned dogs diagnosed with heatstroke.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Logistic regression analysis was performed to identify clinicopathologic variables, available in the first 24 hours of hospitalization, which were associated with outcome (P ≤ 0.1). These were subjected to further analyses. In Model A, continuous variables were divided into quartiles, and logistic regression was performed to yield quartile-specific odds ratios (ORs) for the outcome. Model A was developed, assigning weighted values to each quartile, based on its corresponding OR for the outcome. An individual predictive score was calculated for each dog by summating all weighted values. Model B was a multivariable logistic regression model. Receiver operator characteristic (ROC) analyses were performed to assess models' performance and to calculate sensitivity, specificity, and optimal cutoff points. The overall mortality rate was 53%. The total predictive score (Model A) was negatively and significantly (P < 0.001) associated with probability of survival. The areas under the ROC curve for Models A and B were 0.92 and 0.86, respectively. The optimal cutoff score for Model A was 35.0, corresponding to sensitivity of 93% and specificity of 86%, correctly classifying 90% of the cases.

CONCLUSIONS AND CLINICAL RELEVANCE

The proposed models are applicable, allowing objective assessment of the severity and prognosis of heatstroke in dogs; however, they should be validated further in an independent cohort, and used cautiously for assessment of individual cases.

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.

Prognostic analytes in dogs with Leishmania infantum infection living in a non-endemic area

Due to increasing numbers of dogs that are imported from, or have been visiting Mediterranean countries, canine leishmaniasis has become a very important infectious disease in Germany. The aim of this study was to determine which laboratory and clinical parameters can be used as prognostic factors, whether level of antibody titre is a prognostic factor, and whether treatment leads to a better prognosis in a country in which reinfection is extremely unlikely. Data of 72 dogs infected with Leishmania infantum that had been presented to the Clinic of Small Animal Medicine of the LMU University of Munich, Germany, and whose owners answered a detailed questionnaire, were reviewed retrospectively. All dogs included in the study had clinical signs compatible with canine leishmaniasis. No correlation between the level of antibody titres (carried out by immunofluorescence assay) and survival time was found (p = 0.982). However, there was a significant correlation between survival time and presence of proteinuria (p < 0.001), hypoalbuminemia (p = 0.002), and lymphopenia (p = 0.040) in all treated dogs. Furthermore, treatment of diseased dogs resulted in a longer survival time (p = 0.003). In conclusion, levels of antibody titres did not correlate with prognosis. More useful parameters to predict shorter survival were proteinuria, hypoalbuminemia and lymphopenia. Also, treatment was correlated with a longer survival of almost two years.

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.