Evaluation of the neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios in critically ill dogs

Retrospective Evaluation of Hematological Ratios in Dogs With Nonassociative Immune-Mediated Hemolytic Anemia: 206 Cases

BACKGROUND

The utility of hematological ratios in immune-mediated hemolytic anemia (IMHA) in dogs has seldom been investigated.

HYPOTHESIS

Hematological ratios are associated with disease severity and outcome in dogs with IMHA.

ANIMALS

Two hundred and six client-owned dogs with non-associative IMHA.

METHODS

Retrospective multicenter study. Medical records were reviewed to identify dogs with non-associative IMHA. The neutrophil-to-lymphocyte (NLR), neutrophil-to-monocyte (NMR), band neutrophil-to-segmented neutrophil (BNR), platelet-to-lymphocyte (PLR), monocyte-to-lymphocyte (MLR), neutrophil-to-platelet (NPR) and red blood cell distribution width-to-platelet (RDWPR) ratios were retrospectively calculated. Their association with hematological variables, number of blood transfusions, and survival at discharge, 1 month, and 6 months was evaluated.

RESULTS

Of the 206 dogs included, 164 (80%, 95% confidence interval [CI]: 74-85), 144 (70%, 95% CI: 64-76), and 114 (55%; 95% CI: 48-62) were alive at discharge, one month, and six months, respectively. The hematological ratios were not associated with survival at any time point, regardless of treatment before referral. Only the RDWPR was associated with blood product requirement (odds ratio [OR], 0.70; 95% CI: 0.54-0.91; p < 0.01). Dogs that had received glucocorticoids before referral had a higher 1-month mortality rate compared with glucocorticoid-naïve dogs (73% and 67%, respectively; OR, 2.2; 95% CI: 1.1-4.5; p = 0.03).

CONCLUSIONS AND CLINICAL IMPORTANCE

Hematological ratios had limited value in predicting outcome or disease severity in a large population of dogs with non-associative IMHA. Glucocorticoid treatment before referral was independently associated with decreased survival, likely reflecting selection bias toward dogs with more severe disease.

Evaluation of hematologic indices in parvovirus infected dogs with systemic inflammatory response syndrome (SIRS)

Canine parvoviral enteritis (CPE) is a highly contagious, acute viral disease that mainly affects young dogs and can lead to systemic inflammatory response syndrome (SIRS), sepsis, endotoxemia and even death. The study aimed to evaluate the diagnostic and prognostic potential of hematological indices such as MLR, NLR, PLR, PNR and SII in CPV-infected dogs with SIRS at first admission. The retrospective study was performed on 51 CPV-infected and 20 healthy dogs. MLR, NLR, PLR, PNR, and SII indices were determined and compared between groups. A receiver operating characteristic (ROC) curve analysis was carried out to determine thresholds of sensitivity and specificity for hematologic indices. NLR, PLR, and PNR were the best predictors for supporting a diagnosis of parvoviral enteritis, with AUC values of 0.685, 0.762, and 0.884, respectively. Moreover, PLR and PNR, with AUC values of 0.740 and 0.769, respectively, were the most suitable indices to determine the prognosis of dogs with parvoviral enteritis with SIRS. In conclusion, these indices can be used as potential indicators for predicting disease outcomes and supporting a diagnosis of CPV-infected dogs with SIRS at first admission.

Retrospective evaluation of the neutrophil-to-lymphocyte ratio as a prognostic marker in cats with blunt trauma (2018-2021): 177 cases

OBJECTIVE

To investigate the utility of the neutrophil-to-lymphocyte ratio (NLR) as a prognostic marker in cats with blunt trauma.

DESIGN

Retrospective study from January 2018 to December 2021.

SETTING

University teaching hospital.

ANIMALS

Medical records of 177 cats admitted with blunt trauma were evaluated. History, clinical findings, blood cell count-based ratios, thoracic radiographs on presentation, and outcome were reviewed. The Animal Trauma Triage (ATT) score was assessed in each cat and classified as mild (1-3), moderate (4-7), and severe trauma (≥8). Forty-eight healthy blood donor cats served as the control population. NLR, neutrophil counts, and lymphocyte counts were compared between cats with blunt trauma and controls, and among trauma patients.

INTERVENTIONS

None MEASUREMENTS AND MAIN RESULTS: NLR, neutrophil counts, and lymphocyte counts significantly differ in cats with blunt trauma compared to controls (p < 0.001), and NLR was higher in patients with thoracic trauma (p = 0.044). Nonsurvivors had lower lymphocyte counts (p = 0.041), although those values do not appear to be clinically relevant. A significant increase in NLR was observed with increasing severity of trauma (p < 0.001). The NLR was not associated with the length of hospitalization, intensive care assistance, or mortality.

CONCLUSION

NLR is a widely available diagnostic tool, which can be used in addition to ATT to assess trauma severity, although in our study it was not predictive of the outcome.

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

BACKGROUND

Information is limited regarding the prevalence and importance of hepatic histologic abnormalities in dogs with gallbladder mucocele (GBM).

OBJECTIVES

To (a) report prevalence of hepatic histologic abnormalities in dogs with GBM (b) evaluate for association between hepatic abnormalities and outcome in dogs with GBM (c) evaluate whether neutrophil-to-lymphocyte ratio (NLR) differs in dogs with GBM with and without specific hepatic lesions.

ANIMALS

Fifty-two dogs with grossly and histologically confirmed GBM.

METHODS

Multicenter, retrospective study of dogs with GBM undergoing cholecystectomy with concurrent liver biopsy. Archived histological sections of gallbladder and liver evaluated by investigators blinded to data. Proportions of dogs with each histologic abnormality alive vs deceased at 1, 3, and 12 months post-cholecystectomy compared. Mann-Whitney U performed to determine if NLR differed in dogs with or without selected lesions.

RESULTS

51/52 (98%, 95% CI [89%, 99%]) dogs with GBM had at least 1 hepatic histologic abnormality. Hepatic fibrosis (37/51; 73%, 95% CI [59%, 83%]), biliary hyperplasia (29/52; 56%, 95% CI [42%, 68%]), and portal inflammation (25/52; 48%, 95% CI [35%, 61%]) were most common. The proportion of dogs alive vs dead differed based on the fibrosis score at 1, 3, and 12 (P ≤ .04) months post-cholecystectomy. Dogs with hepatic necrosis (P = .006) and cholangitis/cholangiohepatitis (P = .02) had higher NLRs compared to dogs without these lesions.

CONCLUSIONS AND CLINICAL IMPORTANCE

Histologic abnormalities of the liver are common in dogs with GBM. A higher portal fibrosis score might be associated with shortened long-term survival after cholecystectomy for dogs with GBM. An increase in NLR might predict hepatic necrosis and cholangitis/cholangiohepatitis in dogs with GBM.

Retrospective evaluation of hematological ratios in canine parvovirosis: 401 cases

BACKGROUND

The utility of neutrophil-to-lymphocyte ratio (NLR), platelet to-lymphocyte ratio (PLR) and monocyte-to-lymphocyte ratio (MLR) as prognostic indicators has not been investigated in canine parvovirosis (CPV).

HYPOTHESIS

To evaluate whether these hematological ratios obtained at hospital admission in CPV are associated with outcome or duration of hospitalization.

ANIMALS

Four hundred one client-owned dogs presented with CPV. Methods-Retrospective multicenter cohort study. Medical records were reviewed to identify dogs with CPV. Data regarding signalment, complete blood count at admission, duration of hospitalization and outcome were collected.

RESULTS

Of the 401 dogs included in the study, 336 (83.8%) survived to discharge. The median (25th and 75th percentiles) PLR in nonsurvivors (336.56 [159.84-635.77]) was significantly higher than in survivors (217.65 [117.67-389.65]) (P = .003). The area under the receiver-operating characteristic curve for nonsurvival was 0.615 (95% CI [0.593-0.691], P = .003). A cut off of 700 showed a 21.5% sensitivity and 90% specificity for nonsurvival. No association was observed between hospitalization duration and either hematological ratios or total WBC counts. The median (25th and 75th percentiles) lymphocyte count was below reference interval in all dogs and was significantly lower in the dogs which died (0.82 × 109 /L [0.5-1.87]) than in survivors (1.27 × 109 /L [0.73-2.22]) (P = .005). The median (25th and 75th percentiles) monocyte count however was lower in survivors (0.38 × 109 /L [0.29-1.59]), than in nonsurvivors (0.73 × 109 /L [0.1-2]) (P = .002).

CONCLUSIONS

Evaluation of PLR at hospital admission might be a useful marker of disease severity and could have prognostic value in dogs with CPV.