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Salord Torres X, Jeevaratnam K, Schofield I, Taylor S, Stallwood J, Heyes M, Hughes D, Defauw P. Diagnostic and predictive ability of hyperbilirubinemia severity in cats: A multicenter retrospective study. J Vet Intern Med 2024; 38:1043-1050. [PMID: 38361342 PMCID: PMC10937506 DOI: 10.1111/jvim.17005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Total serum bilirubin concentration (TBIL) can provide useful information on several pathophysiological conditions in cats. Nevertheless, whether the variable severity classification of hyperbilirubinemia can reliably indicate certain disease processes or predict a biliary obstruction (BO) has not been investigated. HYPOTHESIS/OBJECTIVE Determine if hyperbilirubinemia of variable severity can assist clinicians to identify BO, which often is considered a surgical emergency. ANIMALS Two-hundred sixteen client-owned cats. METHODS Data were retrospectively collected from all cats (January 2015-August 2022) with an increased TBIL (>0.58 mg/dL [>10 μmol/L]) presented to 3 referral centers in the United Kingdom (UK). Presenting clinical features and diagnostic outcomes were collected. The predictive ability of TBIL to indicate BO was evaluated by multivariable binary logistic regression modeling and receiver operating characteristic (ROC) curves. RESULTS Median TBIL was 1.73 mg/dL (range, 0.59-26.15; 29.5 μmol/L; range, 10.1-447.1) with severity classification of hyperbilirubinemia categorized as mild (>0.58-2.92 mg/dL; >10-50 μmol/L; 68.1%), moderate (>2.92-5.85 mg/dL; >50-100 μmol/L; 17.6%), severe (>5.85-11.70 mg/dL; >100-200 μmol/L; 9.7%) and very severe (>11.70 mg/dL; >200 μmol/L; 4.6%). Biliary obstruction was present in 17 (7.9%) cats, all of which received recommendation for emergency surgery. Median TBIL in cats with BO (9.69 mg/dL; 165.7 μmol/L) differed significantly from those without obstruction (1.51 mg/dL; 25.8 μmol/L; P < .01). The optimal TBIL cut-off to discriminate between cats with and without BO was ≥3.86 mg/dL (≥66 μmol/L) with a sensitivity of 94.1% and specificity of 82.4%. Using multivariable logistic regression, as age increased, the odds of BO increased significantly (odds ratio, 1.20; 95% confidence interval, 1.01-1.42; P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE As part of a thorough clinical assessment, the severity classification of hyperbilirubinemia has the potential to predict the likelihood of a BO and to discriminate between cats that may or may not require surgery for BO at a suggested cut-off of ≥3.86 mg/dL (≥66 μmol/L). Alongside TBIL, age is also useful when assessing for the likelihood of BO in a cat presented with hyperbilirubinemia.
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Affiliation(s)
- Xavier Salord Torres
- Lumbry Park Veterinary Specialists (CVS)AltonUK
- University of Surrey School of Veterinary MedicineGuildfordUK
| | | | | | - Samantha Taylor
- Lumbry Park Veterinary Specialists (CVS)AltonUK
- University of Surrey School of Veterinary MedicineGuildfordUK
- Linnaeous Veterinary LimitedShirleyUK
- International Society of Feline MedicineTisburyUK
| | - Jennifer Stallwood
- Bristol Veterinary Specialists (former Highcroft Veterinary Referrals) (CVS)BristolUK
| | - Menai Heyes
- ChesterGates Veterinary Specialists (CVS)ChesterUK
| | - Daniel Hughes
- University of Surrey School of Veterinary MedicineGuildfordUK
| | - Pieter Defauw
- Lumbry Park Veterinary Specialists (CVS)AltonUK
- University of Surrey School of Veterinary MedicineGuildfordUK
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Taylor SS, Coggins S, Barker EN, Gunn-Moore D, Jeevaratnam K, Norris JM, Hughes D, Stacey E, MacFarlane L, O'Brien C, Korman R, McLauchlan G, Salord Torres X, Taylor A, Bongers J, Espada Castro L, Foreman M, McMurrough J, Thomas B, Royaux E, Calvo Saiz I, Bertoldi G, Harlos C, Work M, Prior C, Sorrell S, Malik R, Tasker S. Retrospective study and outcome of 307 cats with feline infectious peritonitis treated with legally sourced veterinary compounded preparations of remdesivir and GS-441524 (2020-2022). J Feline Med Surg 2023; 25:1098612X231194460. [PMID: 37732386 DOI: 10.1177/1098612x231194460] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
OBJECTIVES Feline infectious peritonitis (FIP) is a serious disease that arises due to feline coronavirus infection. The nucleoside analogues remdesivir and GS-441524 can be effective in its treatment, but most studies have used unregulated products of unknown composition. The aim of the present study was to describe the treatment of FIP using legally sourced veterinary-prescribed regulated veterinary compounded products containing known amounts of remdesivir (injectable) or GS-441524 (oral tablets). METHODS Cats were recruited via email advice services, product sales contacts and study publicity. Cats were excluded if they were deemed unlikely to have FIP, were not treated exclusively with the veterinary compounded products, or if there was a lack of cat and/or treatment (including response) data. Extensive cat and treatment data were collected. RESULTS Among the 307 cats recruited, the predominant type of FIP was most commonly abdominal effusive (49.5%) and then neurological (14.3%). Three treatment protocols were used; remdesivir alone (33.9%), remdesivir followed by GS-441524 (55.7%) and GS-441524 alone (10.4%). The median (range) initial treatment period duration and longest follow-up time point after starting treatment were 84 (1-330) days and 248 (1-814) days, respectively. The most common side effect was injection pain (in 47.8% of those given subcutaneous remdesivir). Of the 307 cats, 33 (10.8%) relapsed, 15 (45.5%) during and 18 (54.5%) after the initial treatment period. At the longest follow-up time point after completion of the initial treatment period, 84.4% of cats were alive. The cats achieving a complete response within 30 days of starting treatment were significantly more likely to be alive at the end of the initial treatment period than those cats that did not. CONCLUSIONS AND RELEVANCE Legally sourced remdesivir and GS-441524 products, either alone or used sequentially, were very effective in the treatment of FIP in this group of cats. Variable protocols precluded statistical comparison of treatment regimens.
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Affiliation(s)
- Samantha S Taylor
- International Society of Feline Medicine, Tisbury, UK
- Linnaeus Veterinary Limited, Shirley, UK
- University of Surrey, Guildford, UK
| | | | - Emi N Barker
- Langford Vets, University of Bristol, Langford, UK
- Bristol Veterinary School, University of Bristol, Langford, UK
| | | | | | | | - David Hughes
- Concord Veterinary Hospital, Sydney, NSW, Australia
| | | | | | | | | | | | | | - Aimee Taylor
- Langford Vets, University of Bristol, Langford, UK
| | | | | | | | | | | | | | | | | | | | - Megan Work
- Willows Veterinary Centre and Referral Service, Shirley, UK
| | - Cameron Prior
- Willows Veterinary Centre and Referral Service, Shirley, UK
| | | | | | - Séverine Tasker
- Linnaeus Veterinary Limited, Shirley, UK
- Bristol Veterinary School, University of Bristol, Langford, UK
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Salord Torres X, Dobromylskyj M, Sánchez Jiménez C, Plested M, Purzycka K, Phillips M, Mullowney D. Bilateral renal histiocytic sarcoma with disseminated lung involvement in a Siberian Forest Cat. JFMS Open Rep 2023; 9:20551169231191076. [PMID: 37614780 PMCID: PMC10443916 DOI: 10.1177/20551169231191076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
Case summary A 5-year-old female neutered Siberian Forest Cat presented with a 7-day history of lethargy, hyporexia and weight loss. Abdominal ultrasonography revealed bilateral renal changes suggestive of neoplasia. Thoracic radiography documented diffuse pulmonary nodules. The cat was euthanased during diagnostic investigations. Histopathological assessment and immunohistochemical staining of post-mortem renal biopsies were consistent with a histiocytic lesion, most likely histiocytic sarcoma (HS). The lung lesions were suspected of representing disseminated disease. Relevance and novel information HS is considered a rare neoplastic process in cats. This report describes a case of feline bilateral renal HS with suspected concomitant pulmonary involvement. A primary renal origin was suspected, with the lung lesions being a result of disseminated disease. Renal HS should be included as a differential diagnosis when renal ultrasonography reveals changes suggestive of neoplasia.
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Affiliation(s)
| | | | | | - Mark Plested
- Lumbry Park Veterinary Specialists (CVS Group), Alton, Hampshire, UK
| | | | | | - Deirdre Mullowney
- Lumbry Park Veterinary Specialists (CVS Group), Alton, Hampshire, UK
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