Retrospective evaluation of the use of quick Sepsis-related Organ Failure Assessment (qSOFA) as predictor of mortality and length of hospitalization in dogs with pyometra (2013-2019): 52 cases

Evaluation of SIRS and qSOFA in the diagnosis of sepsis in dogs with pyometra

This study aims to evaluate the usability of systemic inflammatory response syndrome (SIRS) and quick sequential organ failure assessment (qSOFA) scores developed for the rapid, reliable and accurate detection of sepsis and organ damage in dogs with pyometra. In the study, dogs with clinical findings (depression, anorexia, weakness, polyuria, polydipsia, fever), diagnosed with pyometra as a result of gynecological, clinical and laboratory examinations and treated surgically (n = 20) were included in the pyometra group. Healthy dogs that underwent routine ovariohysterectomy (n = 20) were added to the control group. In both groups, complete blood and serum biochemistry (aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, creatinine, blood urea nitrogen, albumin, creatine kinase) analyses were performed at the time of diagnosis in the preoperative period. SIRS and qSOFA scores were measured in both groups before surgery and on the third postoperative day. According to the data obtained as a result of the study, the sensitivity and selectivity of qSOFA score in the diagnosis of pyometra were determined to be 65 % and 100 %, respectively. SIRS score was found to have a sensitivity of 95 % and a selectivity of 100 %. The AUC values of SIRS and qSOFA scores were determined as 0.985 and 0.896, respectively. These results indicate that the qSOFA score has good performance in the diagnosis of pyometra, but lower accuracy than the SIRS score, and the SIRS score has high accuracy in the diagnosis of dogs with pyometra. SIRS is a more accurate and reliable screening tool in the diagnosis of dogs with pyometra at risk of sepsis.

Evaluation of the modified quick sequential organ failure assessment scoring system for triage and prognostic assessment in canine emergency and critically ill patients: a retrospective study

BACKGROUND

In veterinary medicine, the qSOFA model has been studied in patients with conditions such as peritonitis or pyometra, and among the modified qSOFA models, only the qSOFA-lactate model has been researched. Thus, this study aimed to evaluate the effectiveness of q-SOFA-C-reactive protein (CRP), qSOFA-lactate, and quick systemic inflammatory response syndrome (qSIRS) models for triaging emergency and critically ill patients. These models were juxtaposed with conventional systems (SIRS, qSOFA, and acute patient physiology and laboratory evaluation [APPLE] fast) to ascertain their efficacy in patient triage and prognostication. In this retrospective cohort study, data from 166 dogs admitted to the Department of Emergency and Critical care at Konkuk Veterinary Medical Teaching Hospital between February 2021 and May 2023 were analyzed. Scoring systems were computed based on initial admission physical examinations (respiratory rate, heart rate, temperature, mentation, and systolic blood pressure) and laboratory results (white blood cell and platelet count and albumin, glucose, lactate, and CRP levels). Because no prior veterinary studies on the qSOFA-CRP model were available, optimal cutoff values were established using receiver operating characteristic (ROC) curves and the Youden index. Conventional scoring systems were compared with the modified qSOFA within the survivor and non-survivor groups. The most effective system was determined through ROC curve analysis.

RESULTS

For the qSOFA-CRP model, we identified an optimal cutoff value for CRP at > 1.55 mg/dL. All modified qSOFA scoring systems showed significant differences between survivors and non-survivors, in contrast to the conventional scoring systems. Notably, the qSOFA-CRP model demonstrated the highest area under the ROC curve value (0.761, 95% CI 0.68-0.83) and odds ratio (13.373, p < 0.001) when evaluating mortality at 28 days.

CONCLUSIONS

The qSOFA-CRP model, when employing a CRP threshold of 1.55 mg/dL, demonstrated promising potential as a novel criterion for triaging emergency and critically ill patients. However, further assessment is required in a larger population of patients at the precise early stage of sepsis.

Bioactive Adrenomedullin in Dogs with Sepsis and Septic Shock: A Prospective, Case-Control Study

Sepsis and septic shock are leading causes of morbidity and mortality in both humans and dogs, and early diagnosis is crucial for improving outcomes. This study aimed to evaluate bioactive adrenomedullin (bio-ADM) concentrations in dogs with septic shock (n = 25), dogs with sepsis without evidence of shock (n = 25), and healthy control dogs (n = 25). Plasma bio-ADM concentrations were measured using a human sandwich enzyme-linked immunosorbent assay and reported as median (interquartile range). Plasma bio-ADM concentrations were significantly higher in both septic groups compared to the healthy controls (all <22.4 pg/mL), but not significantly different between the septic shock (75.0 [28.7-115.0] pg/mL) and sepsis (30.7 [22.4-79.7] pg/mL) groups. Dogs with higher illness severity scores had significantly higher bio-ADM concentrations (93.1 [32.2-122.0] pg/mL) than those with lower scores (29.8 [22.4-71.2] pg/mL). However, bio-ADM concentrations did not differ between survivors (33.0 [22.7-76.7] pg/mL) and non-survivors (74.7 [26.1-123.2] pg/mL). Measurement of bio-ADM is a potential marker for canine sepsis, but not for the identification of septic shock, and may provide information on disease severity. Further studies, including those on non-infectious inflammatory conditions, are necessary to better understand the diagnostic utility of bio-ADM measurement and its potential role as a marker of treatment response in dogs with sepsis.

Defining sepsis in small animals

OBJECTIVE

To discuss the definitions of sepsis in human and veterinary medicine.

DESIGN

International, multicenter position statement on the need for consensus definitions of sepsis in veterinary medicine.

SETTING

Veterinary private practice and university teaching hospitals.

ANIMALS

Dogs and cats.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Sepsis is a life-threatening condition associated with the body's response to an infection. In human medicine, sepsis has been defined by consensus on 3 occasions, most recently in 2016. In veterinary medicine, there is little uniformity in how sepsis is defined and no consensus on how to identify it clinically. Most publications rely on modified criteria derived from the 1991 and 2001 human consensus definitions. There is a divergence between the human and veterinary descriptions of sepsis and no consensus on how to diagnose the syndrome. This impedes research, hampers the translation of pathophysiology insights to the clinic, and limits our abilities to optimize patient care. It may be time to formally define sepsis in veterinary medicine to help the field move forward. In this narrative review, we present a synopsis of prior attempts to define sepsis in human and veterinary medicine, discuss developments in our understanding, and highlight some criticisms and shortcomings of existing schemes.

CONCLUSIONS

This review is intended to serve as the foundation of current efforts to establish a consensus definition for sepsis in small animals and ultimately generate evidence-based criteria for its recognition in veterinary clinical practice.

Pyometra in Small Animals 3.0

Pyometra is a common disease in intact bitches and queens and occurs, although less frequently, in most other female pets. In bitches and queens, the illness is generally diagnosed within 4 months after estrus, in middle-aged to older individuals. Complications such as peritonitis, endotoxemia, and systemic inflammatory response syndrome are not uncommon and associated with more severe illness. Ovary-sparing surgical options such as hysterectomy could be considered in individuals with high-risk for detrimental side effects of spaying or without infection of the uterus but has not yet been evaluated for safety in pyometra.