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Becher A, Acke E, Serrano G, Kiefer I, Alef M, von Bomhard W, Heilmann RM. Evaluation of the Blood Neutrophil-to-Lymphocyte Ratio (NLR) as a Diagnostic and Prognostic Biomarker in Dogs with Portosystemic Shunt. Vet Sci 2024; 11:80. [PMID: 38393098 PMCID: PMC10893402 DOI: 10.3390/vetsci11020080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/25/2024] Open
Abstract
The neutrophil-to-lymphocyte ratio (NLR) can help in assessing inflammatory diseases, sepsis, and chronic hepatic conditions in humans. Dogs with congenital portosystemic shunts (PSSs) have signs of generalized inflammation, and the clinical signs can overlap with other conditions, including hypoadrenocorticism (HOC). Thus, the potential diagnostic and prognostic value of leukocyte ratios as surrogate markers was assessed in a retrospective case-control study including 106 dogs diagnosed with PSSs. The disease control groups were dogs with parenchymal hepatopathy (PH; n = 22) or HOC (n = 31). In the PSS dogs, the blood NLRs were associated with the severity of systemic inflammation but not with the shunt type, hepatoencephalopathy, systemic infection, or hypoglycemia. The baseline NLRs did not differ between the three disease groups, between medically and surgically treated PSS dogs, or between those with successful PSS ligation and dogs experiencing peri-/post-surgical complications. However, dogs requiring two consecutive surgical interventions had significantly higher NLRs, and an NLR of <2.53 distinguished dogs with successful shunt ligation in one surgery from those requiring two consecutive surgeries for PSS closure. The blood NLR might be a useful clinicopathologic variable in PSS, but its value in helping differentiate PSS from HOC cases appears low. Integrating the NLR into a diagnostic algorithm may allow for a prediction of the number of surgical interventions required.
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Affiliation(s)
- Anja Becher
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
| | - Els Acke
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
- IDEXX Vet Med Labor GmbH, 70806 Kornwestheim, BW, Germany
| | - Gonçalo Serrano
- Small Animal Department, Faculty of Veterinary Medicine, Ghent University, 9820 Merelbeke, Belgium;
- AniCura Haaglanden Specialist Referral Centre, 2288 EZ Rijswijk, The Netherlands
| | - Ingmar Kiefer
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
| | - Michaele Alef
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
| | - Wolf von Bomhard
- Antech Specialty Center for Veterinary Pathology, 81477 Munich, BY, Germany;
| | - Romy M. Heilmann
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, 04103 Leipzig, SN, Germany; (A.B.); (E.A.); (I.K.); (M.A.)
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Lee N, Choi J, Yoon J. Presumptive nontraumatic adrenal hemorrhage preceding hypoadrenocorticism in a dog. Vet Med (Auckl) 2022; 36:2160-2164. [PMID: 36086914 DOI: 10.1111/jvim.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022]
Abstract
Nontraumatic adrenal hemorrhage (NTAH) has been associated with stress-induced catecholamines release in underlying conditions such as sepsis and recent surgery in humans. It can lead to primary hypoadrenocorticism (HOAC) when both adrenal glands are involved, with nonspecific clinical signs and laboratory findings that can lead to a missed diagnosis. Bilateral thickening of the adrenal glands with periadrenal fat stranding was identified in a 10-year-old male Maltese dog after abdominal surgery. The dog showed clinical signs and biochemical changes consistent with HOAC, but treatment for presumed critical illness-related corticosteroid insufficiency was initiated. Clinical signs relapsed with a 3-week dose reduction of hydrocortisone, and a reduction in adrenal size was observed on follow-up ultrasound examination. Hormonal testing confirmed HOAC in the dog. To the best of our knowledge, HOAC caused by spontaneous NTAH has not been reported in the veterinary literature. This report describes a dog that developed HOAC with presumed adrenal atrophy after suspected spontaneous bilateral NTAH.
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Affiliation(s)
- Namsoon Lee
- Time Animal Medical Center, Daejeon, South Korea.,College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Jihye Choi
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
| | - Junghee Yoon
- College of Veterinary Medicine and the Research Institute for Veterinary Science, Seoul National University, Seoul, South Korea
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3
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Cole LP, Hardas A, Priestnall SL, Tinson EW. Waterhouse-Friderichsen syndrome in a cat with Klebsiella spp. infection. J Vet Emerg Crit Care (San Antonio) 2021; 31:531-536. [PMID: 33949088 DOI: 10.1111/vec.13063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/24/2020] [Accepted: 02/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe a case of Waterhouse-Friderichsen syndrome of adrenocortical failure in a cat with Klebsiella spp. infection. CASE SUMMARY A 12-year-old male neutered domestic short-haired cat was referred for respiratory failure requiring mechanical ventilation. The cat remained comatose despite successful weaning from the ventilator and developed a Klebsiella pneumoniae pneumonia. On day 4 of hospitalization, the cat acutely deteriorated with profound hypotension, azotemia, and hyperkalemia, which rapidly progressed to cardiac arrest. Necropsy findings revealed massive adrenal hemorrhage and intralesional bacteria, termed Waterhouse-Friderichsen syndrome. Waterhouse-Friderichsen syndrome was suspected to have been the cause of acquired adrenocortical insufficiency and sudden death of the cat. NEW OR UNIQUE INFORMATION To the authors' knowledge, this is the first report of sepsis causing Waterhouse-Friderichsen syndrome in a veterinary species.
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Affiliation(s)
- Laura P Cole
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
| | - Alexandros Hardas
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Simon L Priestnall
- Department of Pathobiology and Population Sciences, The Royal Veterinary College, Hatfield, UK
| | - Erica W Tinson
- Department of Clinical Science and Services, The Royal Veterinary College, Hatfield, UK
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4
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Marchetti M, Pierini A, Favilla G, Marchetti V. Critical illness-related corticosteroid insufficiency in dogs with systemic inflammatory response syndrome: A pilot study in 21 dogs. Vet J 2021; 273:105677. [PMID: 34148600 DOI: 10.1016/j.tvjl.2021.105677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/07/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022]
Abstract
Critical illness-related corticosteroid insufficiency (CIRCI) refers to a lack of adequate corticosteroid activity, which occurs in up to 48% of dogs with sepsis. However, data regarding the occurrence of CIRCI in critically-ill dogs are still scarce. This study aimed to assess: (1) the relationship between CIRCI and clinicopathological inflammatory markers, hypotension and mortality; and (2) the impact of low-dose hydrocortisone treatment on survival. Twenty-one dogs diagnosed with systemic inflammatory response syndrome (SIRS) were enrolled in a prospective case-control study. All dogs were initially evaluated for adrenal function with an ACTH stimulation test and dogs with Δcortisol ≤ 3 μg/dL were diagnosed with CIRCI. Mean arterial pressure (MAP), white blood cell (WBC), band neutrophils (bNs), c-reactive protein (CRP), and 28-day mortality rate were assessed. Fourteen dogs were treated with low-dose hydrocortisone. The relationships between CIRCI and MAP, WBC, bN, CRP, basal cortisol and mortality were investigated, as was the association between mortality and hydrocortisone treatment. Ten of 21 (48%) dogs were diagnosed with CIRCI. Increased bNs were associated with the presence of CIRCI (P = 0.0075). CRP was higher in dogs with CIRCI (P = 0.02). Fourteen of 21 (66%) dogs died during the study (6/14 had CIRCI). Basal hypercortisolemia (>5 μg/dL) was associated with increased risk of mortality (P = 0.025). Based on our diagnostic criteria, CIRCI occurs frequently in dogs with SIRS and was associated with increased bNs and increased CRP. In this study, CIRCI and low-dose hydrocortisone treatment were not significantly associated with mortality, but basal hypercortisolemia was associated with increased mortality.
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Affiliation(s)
- M Marchetti
- Department of Veterinary Science, University of Pisa, via livornese lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - A Pierini
- Department of Veterinary Science, University of Pisa, via livornese lato monte, San Piero a Grado, 56122, Pisa, Italy.
| | - G Favilla
- Department of Veterinary Science, University of Pisa, via livornese lato monte, San Piero a Grado, 56122, Pisa, Italy
| | - V Marchetti
- Department of Veterinary Science, University of Pisa, via livornese lato monte, San Piero a Grado, 56122, Pisa, Italy
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Summers AM, Culler C, Yaxley PE, Guillaumin J. Retrospective evaluation of the use of hydrocortisone for treatment of suspected critical illness-related corticosteroid insufficiency (CIRCI) in dogs with septic shock (2010-2017): 47 cases. J Vet Emerg Crit Care (San Antonio) 2021; 31:371-379. [PMID: 33599090 DOI: 10.1111/vec.13037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate characteristics of septic shock patients treated with hydrocortisone (HC) due to suspicion of critical illness-related corticosteroid insufficiency (CIRCI) as compared to septic shock patients without suspicion of CIRCI. DESIGN Retrospective study between February 2010 and October 2017. SETTING University teaching hospital ICU. ANIMALS Data were collected for 47 dogs with septic shock. Twenty-one dogs were treated with HC (HC-treated) due to suspicion of CIRCI. Twenty-six dogs did not receive HC (non-HC-treated). INTERVENTIONS HC was administered either as an intermittent IV bolus or as a constant rate infusion (CRI) to those patients with suspected CIRCI. MEASUREMENTS AND MAIN RESULTS Significantly higher baseline APPLEfull scores and predicted mortality were detected in the HC-treated patients compared to non-HC-treated patients (0.87 vs 0.44 for predicted mortality, P = 0.039). Patients in the HC-treated group were on more vasopressors and cardiotonics than those in the non-HC-treated group (2.5 vs 1.5, P <0 .001). All patients initially responded to vasopressor administration, with average time to resolution of hypotension being 90 minutes for the HC-treated group compared to 60 minutes for the non-HC-treated group (P = 0.640). However, HC-treated patients took significantly longer to have a sustained resolution (a systolic blood pressure > 90 mm Hg or a mean blood pressure > 65 mm Hg for at least 4 h) of their hypotension after starting vasopressors, as compared to their non-HC-treated counterparts (8.5 vs 4 h, P = 0.001). Three (14.3%) HC-treated patients survived to discharge compared to 9 (34.6%) non-HC-treated patients, but this was not statistically significant. CONCLUSIONS HC-treated patients had a higher baseline risk of mortality than non-HC-treated patients. There was no significant difference in survival between the HC-treated and non-HC-treated septic shock patients. Further studies are needed to evaluate the use of HC in patients with suspected CIRCI.
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Affiliation(s)
- April M Summers
- Cornell University Hospital for Animals, College of Veterinary Medicine, Ithaca, New York
| | - Christine Culler
- Veterinary Specialty Hospital of the Carolinas, Cary, North Carolina
| | - Page E Yaxley
- The Ohio State University, Department of Clinical Sciences, Columbus, Ohio
| | - Julien Guillaumin
- Colorado State University, Department of Clinical Sciences, Fort Collins, Colorado
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Boag AM, Brown A, Koenigshof A, Homer N, Sooy K, Jamieson PM. Glucocorticoid metabolism in critically ill dogs (Canis lupus familiaris). Domest Anim Endocrinol 2020; 72:106437. [PMID: 32169755 DOI: 10.1016/j.domaniend.2020.106437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/04/2020] [Accepted: 01/15/2020] [Indexed: 02/06/2023]
Abstract
Critical illness due to sepsis is a major global health concern associated with a high burden of mortality and cost. Glucocorticoid dysregulation in human sepsis is associated with poorer outcomes. This study examines glucocorticoid metabolism in septic canine patients to delineate elements of cellular dysregulation in common with critically ill humans and explore potential differences. This was a prospective case-control study conducted in the veterinary specialist critical care departments of two University teaching hospitals. Critically ill canine patients with naturally occurring sepsis or septic shock were compared with an in-hospital control population. Serum total, bound, and free cortisol concentrations were increased in septic shock (P < 0.001), and higher bound cortisol was associated with nonsurvival (P = 0.026). Urinary Gas Chromatography-Tandem Mass Spectrometry was performed to assess urinary glucocorticoid metabolites and estimate intracellular glucocorticoid metabolism. Decreased renal 11β-hydroxysteroid dehydrogenase 2 (11βHSD2) activity inferred from increased urinary cortisol-to-cortisone ratio was observed in critically ill dogs (P < 0.001). Decreased 11βHSD2 activity (P = 0.019) and increased A-ring reduction of cortisone (P = 0.001) were associated with nonsurvival within the critically ill dogs. Intriguingly, two dogs were identified with low circulating total cortisol (<2 mg/dL) associated with increased A-ring reduction of cortisol, not previously described. Investigation of spontaneous canine sepsis and septic shock reveals dysregulation of cortisol to cortisone conversion similar to that observed in human patients, but with differences in A-ring reduction compared with those reported in humans. In addition, two dogs with high levels of cortisol inactivation associated with low circulating cortisol concentrations were identified.
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Affiliation(s)
- A M Boag
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK; The Queen's Medical Research Institute, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK.
| | - A Brown
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK
| | - A Koenigshof
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, Lansing, MI, USA
| | - N Homer
- The Queen's Medical Research Institute, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - K Sooy
- The Queen's Medical Research Institute, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - P M Jamieson
- Hospital for Small Animals, Royal (Dick) School of Veterinary Studies, University of Edinburgh, Edinburgh, UK; The Queen's Medical Research Institute, Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
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7
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Caldin M, Rocchi P, Zoia A, Botto A, Bertolini G, Zappa G, Furlanello T. Thyroid axis and adrenal activity in 28 day survivor and nonsurvivor dogs involved in recent road traffic accidents: A cohort study of 420 dogs. Res Vet Sci 2020; 132:243-249. [PMID: 32645514 DOI: 10.1016/j.rvsc.2020.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 06/20/2020] [Accepted: 06/22/2020] [Indexed: 11/27/2022]
Abstract
The objective of this retrospective cohort study was to determine the impact of a recent trauma on thyroid axis and adrenal activity in dogs and to assess the usefulness of urinary cortisol-to-creatinine ratio (UCCR), basal serum thyroid-stimulating hormone (TSH), total thyroxine (tT4), and free thyroxine (fT4) concentrations in predicting outcome in dogs traumatized by a road traffic accident (RTA). An RTA exposed group of 210 dogs was evaluated within 24 hours of the trauma. Their data were compared with data from a matched group of dogs with other diagnoses. UCCR was positively correlated with the trauma severity and was higher in the exposed group than in the nonexposed group (median 101.500 vs. 21.02; p < 0.0001). tT4 values were statistically similar between the two groups, but were correlated with a trauma score, while TSH (median = 0.050 vs. 0.080 ng/mL; p < 0.0001) and fT4 (median = 15.850 vs. 17.950 pmol/L; p = 0.0037) were significantly lower for the exposed group. Nonsurvivors in comparison to survivors presented and higher median UCCR (181.800 vs. 93.850 respectively; p = 0.020), and a lower serum fT4 (12.700 vs. 16.500 pmol/L, respectively; p = 0.0046). A similar pattern had been observed for tT4. TSH levels were not predictive of survival. This study provides insights into the endocrine characteristics of dogs suffering from acute trauma. UCCR was higher while fT4 and TSH were both lower in RTA-injured dogs than in dogs affected by other conditions. Furthermore low fT4 and tT4, and a high UCCR could be useful prognostic factors in dogs affected by RTA trauma.
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Affiliation(s)
- Marco Caldin
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Paola Rocchi
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Andrea Zoia
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Angelica Botto
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Giovanna Bertolini
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Giovanni Zappa
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy
| | - Tommaso Furlanello
- From San Marco Veterinary Clinic and Laboratory, via dell'Industria 3, Veggiano, Italy.
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Hernandez-Bures A, White AG, Riordan L. Presumptive iatrogenic hypoadrenocorticism induced by high-dose ketoconazole administration in a dog. J Vet Intern Med 2019; 33:2235-2238. [PMID: 31448839 PMCID: PMC6766512 DOI: 10.1111/jvim.15604] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 08/15/2019] [Indexed: 11/29/2022] Open
Abstract
A 11‐year‐old male neutered Shih Tzu was referred to a tertiary facility with a history of weight loss, decreased appetite, polydipsia, and lethargy. The dog had a 10‐year history of nonspecific allergic dermatitis and was being treated with 16 mg/kg of ketoconazole q12h for Malassezia dermatitis. Vague gastrointestinal signs, hypocholesterolemia, and lack of a stress leukogram increased suspicion for hypoadrenocorticism (HA). An adrenocorticotropic hormone (ACTH) stimulation test identified hypocortisolemia on pre‐ and post‐ACTH samples and ketoconazole was discontinued. After a short course of corticosteroid treatment, an ACTH stimulation test was repeated and pre‐ACTH cortisol concentration was within the reference range, and the post‐ACTH cortisol concentration was mildly increased. The temporal association between return of adequate adrenocortical cortisol production and discontinuation of ketoconazole led to the conclusion that the dog had developed iatrogenic HA secondary to ketoconazole treatment.
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Affiliation(s)
| | - Amelia G White
- Dermatology Service, Auburn University College of Veterinary Medicine, Auburn, Alabama
| | - Laura Riordan
- Florida Veterinary Referral Center and 24-Hour Emergency, Estero, Florida
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Thames BE, Barr JW, Suchodolski JS, Steiner JM, Heilmann RM. Prospective evaluation of S100A12 and S100A8/A9 (calprotectin) in dogs with sepsis or the systemic inflammatory response syndrome. J Vet Diagn Invest 2019; 31:645-651. [PMID: 31170888 DOI: 10.1177/1040638719856655] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Pattern recognition receptors (e.g., S100A12 or S100A8/A9) hold promise as inflammatory biomarkers. We prospectively determined and compared serum S100A12 and S100A8/A9 concentrations in dogs with sepsis (n = 11) or systemic inflammatory response syndrome (SIRS; n = 8) over a 3-d period with each other, healthy controls (n = 50), and other clinical and clinicopathologic variables. Serum S100A12 and S100A8/A9 concentrations were significantly higher in dogs with sepsis or SIRS (all p < 0.05) at the time of hospital admission (day 1) compared to healthy controls, with no differences between patient groups. However, septic dogs had significantly lower serum S100A12 concentrations on day 2 and day 3 (both p < 0.05) compared to dogs with SIRS. Likewise, dogs with sepsis had significantly lower S100A8/A9 concentrations on day 2 (p < 0.05). Neither serum S100A12 nor S100A8/A9 concentrations were associated with survival to discharge. Our results suggest a differential expression of the S100/calgranulins between dogs with sepsis and those with SIRS. Serum S100A12 or S100A8/A9 concentration at the time of hospital admission did not differentiate dogs with sepsis from those with SIRS, but the trend of S100/calgranulin concentrations during the following 24-48 h may be a useful surrogate marker for differentiating sepsis from SIRS.
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Affiliation(s)
- Brittany E Thames
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS (Thames)
- BluePearl Veterinary Partners, Tampa, FL (Barr)
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX (Suchodolski, Steiner)
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany (Heilmann)
| | - James W Barr
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS (Thames)
- BluePearl Veterinary Partners, Tampa, FL (Barr)
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX (Suchodolski, Steiner)
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany (Heilmann)
| | - Jan S Suchodolski
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS (Thames)
- BluePearl Veterinary Partners, Tampa, FL (Barr)
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX (Suchodolski, Steiner)
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany (Heilmann)
| | - Jörg M Steiner
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS (Thames)
- BluePearl Veterinary Partners, Tampa, FL (Barr)
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX (Suchodolski, Steiner)
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany (Heilmann)
| | - Romy M Heilmann
- Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Starkville, MS (Thames)
- BluePearl Veterinary Partners, Tampa, FL (Barr)
- Gastrointestinal Laboratory, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX (Suchodolski, Steiner)
- Department for Small Animals, Veterinary Teaching Hospital, College of Veterinary Medicine, University of Leipzig, Leipzig, Germany (Heilmann)
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Pseudohypoadrenocorticism in a Siberian Husky with Trichuris vulpis Infection. Case Rep Vet Med 2019; 2019:3759683. [PMID: 31263625 PMCID: PMC6556295 DOI: 10.1155/2019/3759683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/08/2019] [Accepted: 05/16/2019] [Indexed: 11/17/2022] Open
Abstract
An entire male Siberian Husky presented for diarrhoea, weakness, inappetence, and collapse following a six-day period of illness. On clinical examination the dog displayed vasoconstrictive circulatory shock, dehydration, and melena. Laboratory tests revealed a marked hyponatraemia, hyperkalaemia, and a decreased sodium/potassium ratio of ≤ 12.4. The baseline and poststimulation serum cortisol concentrations were markedly elevated following adrenocorticotropin hormone (ACTH) stimulation test, yielding 712 nmol/L and 706 nmol/L, respectively. The elevated cortisol concentration excluded hypoadrenocorticism. A concurrent Trichuris vulpis (whipworm) infection was also identified. The dog was treated with supportive care including fenbendazole and recovered uneventfully. The final diagnosis was Trichuris vulpis infection with secondary pseudohypoadrenocorticism. This case report further supports a previous observation that the Siberian Husky breed may have an increased sensitivity to infection with Trichuris vulpis and development of pseudohypoadrenocorticism.
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11
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Botsford A, Behrend EN, Kemppainen RJ, Gaillard PR, Oprandy F, Lee HP. Low-dose ACTH stimulation testing in dogs suspected of hypoadrenocorticism. J Vet Intern Med 2018; 32:1886-1890. [PMID: 30230611 PMCID: PMC6272038 DOI: 10.1111/jvim.15256] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 05/23/2018] [Accepted: 06/05/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Low-dose ACTH stimulation testing would lower cost and may increase sensitivity for identification of partial ACTH deficiency. HYPOTHESIS (1) The low-dose ACTH stimulation test will provide comparable results to the standard-dose ACTH stimulation test in dogs suspected of hypoadrenocorticism and (2) partial ACTH deficiency exists in dogs and can result in chronic, intermittent gastrointestinal signs. ANIMALS Thirty-one client-owned dogs suspected of having hypoadrenocorticism. METHODS Prospective study. Dogs suspected of having hypoadrenocorticism received 1 μg/kg cosyntropin IV for the first ACTH stimulation test; the second test was performed 4 h later and dogs received 5 μg/kg cosyntropin IV. Blood samples were obtained pre-ACTH and 1 hour post-ACTH for each dose (4 measurements total). Samples for endogenous ACTH measurement were obtained at the time of initial blood collection. RESULTS No significant difference was observed in the basal cortisol concentration before administration of a 1 μg/kg versus before a 5 μg/kg dose of cosyntropin (P = .544). For dogs suspected of having hypoadrenocorticism, the ACTH-stimulated cortisol concentrations in response to both doses of ACTH were equivalent (90% confidence interval [CI], 80.5-97.2%; P = .04). No cases with partial ACTH deficiency were identified conclusively. CONCLUSIONS AND CLINICAL IMPORTANCE A 1 μg/kg dose of cosyntropin is equivalent to a 5 μg/kg dose of cosyntropin for screening dogs suspected of hypoadrenocorticism. The existence of partial ACTH deficiency was not identified in this small group of dogs.
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Affiliation(s)
- Annabel Botsford
- Department of Clinical Sciences, Auburn University, Auburn, Alabama.,Atlantic Veterinary Internal Medicine and Oncology, Columbia, Maryland
| | - Ellen N Behrend
- Department of Clinical Sciences, Auburn University, Auburn, Alabama
| | - Robert J Kemppainen
- Department of Anatomy, Physiology and Pharmacology, Auburn University, Auburn, Alabama
| | - Philippe R Gaillard
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama
| | - Frank Oprandy
- Department of Mathematics and Statistics, Auburn University, Auburn, Alabama
| | - Hollie P Lee
- Department of Clinical Sciences, Auburn University, Auburn, Alabama
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12
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Heilmann RM, Grützner N, Thames BE, Steiner JM, Barr JW. Serum alpha 1 -proteinase inhibitor concentrations in dogs with systemic inflammatory response syndrome or sepsis. J Vet Emerg Crit Care (San Antonio) 2017; 27:674-683. [PMID: 29068553 DOI: 10.1111/vec.12674] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/08/2016] [Accepted: 04/27/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine whether the concentration of serum canine alpha1 -proteinase inhibitor (cα1 -PI) has diagnostic or prognostic utility in dogs with sepsis or noninfectious systemic inflammatory response syndrome (SIRS). DESIGN Prospective, observational study from May to December 2010. SETTING University teaching hospital ICU. ANIMALS Sixty-nine client-owned dogs: 19 dogs with SIRS or sepsis and 50 healthy control dogs. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Serum and plasma samples were collected from dogs with SIRS or sepsis on the day of hospital admission and once on the following 2 days, and on a single day in healthy controls. Patients were assessed using the 10-parameter Acute Patient Physiologic and Laboratory Evaluation (APPLEfull ) and 5-parameter (APPLEfast ) score. Serum cα1 -PI concentrations were measured, compared among groups of dogs, and evaluated for a correlation with the concentration of serum C-reactive protein, plasma interleukin-6, tumor necrosis factor-α, the APPLE scores, and survival to discharge. Serum cα1 -PI concentrations were significantly lower in dogs with SIRS/sepsis (P < 0.001) than in healthy controls. While day 1 serum cα1 -PI concentrations did not differ between dogs with SIRS and those with sepsis (P = 0.592), septic dogs had significantly lower serum cα1 -PI concentrations on days 2 (P = 0.017) and 3 (P = 0.036) than dogs with SIRS. Serum cα1 -PI concentrations did not differ between survivors and nonsurvivors (P = 1.000), but were inversely correlated with the APPLEfull score (ρ = -0.48; P = 0.040) and plasma interleukin-6 concentrations (ρ = -0.50; P = 0.037). CONCLUSIONS These results suggest a role of cα1 -PI as a negative acute phase protein in dogs. The concentration of serum cα1 -PI at the time of hospital admission does not have utility to identify dogs with sepsis from those with noninfectious SIRS, but may be a useful surrogate marker for early stratification of illness severity.
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Affiliation(s)
- Romy M Heilmann
- Gastrointestinal Laboratory, College Station, TX.,the Department of Small Animal Clinical Sciences, College Station, TX
| | - Niels Grützner
- Gastrointestinal Laboratory, College Station, TX.,College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX.,the Farm Animal Clinic, Vetsuisse Faculty Berne, University of Berne, Bremgartenstrasse, Switzerland
| | - Brittany E Thames
- the Department of Small Animal Clinical Sciences, College Station, TX.,the Department of Clinical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, MS
| | - Jörg M Steiner
- Gastrointestinal Laboratory, College Station, TX.,the Department of Small Animal Clinical Sciences, College Station, TX
| | - James W Barr
- the Department of Small Animal Clinical Sciences, College Station, TX
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13
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Pisano SRR, Howard J, Posthaus H, Kovacevic A, Yozova ID. Hydrocortisone therapy in a cat with vasopressor-refractory septic shock and suspected critical illness-related corticosteroid insufficiency. Clin Case Rep 2017; 5:1123-1129. [PMID: 28680609 PMCID: PMC5494402 DOI: 10.1002/ccr3.1018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 04/05/2017] [Accepted: 05/01/2017] [Indexed: 01/22/2023] Open
Abstract
A 27‐month‐old female cat was presented with septic peritonitis secondary to a ruptured pyometra and subsequent pyothorax. Vasopressor‐refractory septic shock led to a suspicion of critical illness‐related corticosteroid insufficiency, successfully treated with intravenous hydrocortisone. Previous megestrol acetate administration may have played a role in the development of adrenocortical dysfunction.
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Affiliation(s)
- Simone R R Pisano
- Department of Clinical Veterinary Medicine Vetsuisse Faculty University of Bern Bern Switzerland
| | - Judith Howard
- Department of Clinical Veterinary Medicine Vetsuisse Faculty University of Bern Bern Switzerland
| | - Horst Posthaus
- Department of Infectious Diseases and Pathobiology Vetsuisse Faculty University of Bern Bern Switzerland
| | - Alan Kovacevic
- Department of Clinical Veterinary Medicine Vetsuisse Faculty University of Bern Bern Switzerland
| | - Ivayla D Yozova
- Institute of Veterinary, Animal and Biomedical Sciences Massey University Palmerston North New Zealand
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14
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Aharon MA, Prittie JE, Buriko K. A review of associated controversies surrounding glucocorticoid use in veterinary emergency and critical care. J Vet Emerg Crit Care (San Antonio) 2017; 27:267-277. [PMID: 28449321 DOI: 10.1111/vec.12603] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/19/2016] [Accepted: 06/30/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To review the literature in human and veterinary medicine regarding the indications for, efficacy of, and controversies surrounding glucocorticoid (GC) administration in the emergency and critical care (ECC) setting, and to provide an overview of the most commonly used synthetic GC formulations. MEDICATIONS Synthetic GCs vary in GC and mineralocorticoid potency, hypothalamic pituitary axis suppression, duration of action, route of administration, and clinical indication for use. Some of the GC compounds commonly used in human and veterinary ECC include hydrocortisone, prednisone, methylprednisolone, and dexamethasone. INDICATIONS FOR USE GCs are used in human and veterinary ECC for a variety of disorders including anaphylaxis, acute lung injury/acute respiratory distress syndrome, septic shock, and spinal cord injury. Evidence for morbidity or mortality benefit with administration of GC within these populations exists; however, data are sparse and often conflicting. ADVERSE EFFECTS AND CONTRAINDICATIONS Routine use of GC in some conditions such as trauma, hemorrhagic shock, and traumatic brain injury is likely contraindicated. GC use has been associated with hyperglycemia, pneumonia, urinary tract infection, gastrointestinal ulceration, or increased mortality in some populations.
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Affiliation(s)
- Maya A Aharon
- Department of Emergency and Critical Care, Animal Medical Center, New York, NY, 10065
| | - Jennifer E Prittie
- Department of Emergency and Critical Care, Animal Medical Center, New York, NY, 10065
| | - Kate Buriko
- Department of Emergency and Critical Care, Animal Medical Center, New York, NY, 10065
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15
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Wakayama JA, Furrow E, Merkel LK, Armstrong PJ. A retrospective study of dogs with atypical hypoadrenocorticism: a diagnostic cut-off or continuum? J Small Anim Pract 2017; 58:365-371. [PMID: 28247992 DOI: 10.1111/jsap.12649] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Revised: 11/16/2016] [Accepted: 11/30/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To describe the clinicopathologic findings and outcome in dogs with atypical hypoadrenocorticism (Group 1) and dogs with suspected atypical hypoadrenocorticism whose post-adrenocorticotropic hormone stimulation cortisol concentrations were greater than 55 nmol/L but below the laboratory reference interval (Group 2). METHODS Medical records were searched to identify dogs diagnosed with hypoadrenocorticism between January 2004 and June 2014. Dogs were excluded if their Na:K ratio was less than 27 or if they had received prior therapy that could interfere with adrenocorticotropic hormone stimulation testing. RESULTS Forty dogs were included in Group 1 and nine dogs in Group 2. In Group 1, the most common biochemical abnormalities were hypoalbuminaemia (87%) and hypocholesterolaemia (76%). Of 35 dogs in Group 1 with follow-up biochemistry results, five (14%) developed electrolyte abnormalities at 2 to 51 months post diagnosis. Of seven dogs in Group 2 with follow-up, glucocorticoid therapy was discontinued in two dogs without return of clinical signs, four dogs were subsequently diagnosed with inflammatory bowel disease and one dog continued to have clinical signs despite glucocorticoid treatment. CLINICAL SIGNIFICANCE Dogs with gastrointestinal signs and hypoalbuminaemia and, or, hypocholesterolaemia should be evaluated for atypical hypoadrenocorticism. Follow-up electrolyte monitoring is recommended because some will develop electrolyte abnormalities. Although dogs in Group 2 had a clinical presentation compatible with atypical hypoadrenocorticism, the diagnosis appears unlikely based on review of follow-up data. Dogs with equivocal adrenocorticotropic hormone stimulation results should be evaluated for other underlying diseases such as inflammatory bowel disease. The use of endogenous adrenocorticotropic hormone measurements in these dogs warrants investigation.
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Affiliation(s)
- J A Wakayama
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - E Furrow
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - L K Merkel
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
| | - P J Armstrong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, 55108, USA
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16
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Buckley FI, Mahony O, Webster CRL. Adrenal function in cats with cholestatic liver disease. J Vet Diagn Invest 2016; 29:14-19. [DOI: 10.1177/1040638716671978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Cats with cholestatic liver disease experience significant morbidity and mortality when they undergo invasive procedures under anesthesia. Although inadequate adrenal response might account for these outcomes, adrenal function in cats with cholestatic liver disease has not been documented, to our knowledge. The goal of our study was to describe adrenal function in these cats. Twenty-seven cats with a serum bilirubin >230 µmol/L (3 mg/dL) and serum alanine aminotransferase >2 times the upper limit of normal had pre– and 60-min post–adrenocorticotropic hormone (ACTH) cortisol analysis after administration of 5 µg/kg cosyntropin intravenously. The change in cortisol concentrations (delta cortisol) was calculated. Pre- and post-ACTH cortisol concentrations were compared to reference values. Pre-ACTH, post-ACTH, and delta cortisol values were compared between cats surviving to discharge or for 30 d postdischarge. Mean pre-ACTH cortisol levels (205 ± 113 nmol/L [7.4 ± 4.2 µg/dL]) and post-ACTH cortisol levels (440 ± 113 nmol/L [15.9 ± 4.1 g/dL]) in cholestatic cats were significantly greater than reference values in clinically normal cats. There was no association of pre- or post-ACTH cortisol with survival. Cats with a delta cortisol <179 nmol/L (6.5 µg/dL) were more likely to be non-survivors at 30 d post-discharge ( p = 0.037) than cats with delta cortisol >179 nmol/L (6.5 µg/dL). Results indicate that cats with cholestasis have high basal and ACTH-stimulated cortisol values. A delta cortisol <179 nmol/L (6.5 µg/dL) defines a population of cats that have decreased 30-d survival.
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Affiliation(s)
- Faith I. Buckley
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Orla Mahony
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Cynthia R. L. Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
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17
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Creedon JMB. Controversies surrounding critical illness-related corticosteroid insufficiency in animals. J Vet Emerg Crit Care (San Antonio) 2014; 25:107-12. [PMID: 25516097 DOI: 10.1111/vec.12270] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 05/28/2014] [Indexed: 01/26/2023]
Abstract
OBJECTIVES To describe the controversies surrounding critical illness-related corticosteroid insufficiency (CIRCI) and the use of hydrocortisone in critically ill patients, and to present published diagnostic and therapeutic strategies in companion veterinary species. ETIOLOGY Critical illness-related corticosteroid insufficiency may be due to hypothalamic-pituitary-adrenal (HPA) axis dysfunction, alterations in cortisol-plasma protein binding, target cell enzymatic changes, changes in glucocorticoid receptor (GR) function, or a combination of these or other factors present during critical illness. DIAGNOSIS Appropriate tests to diagnose CIRCI are unknown. The diagnosis in people is currently based on response to treatment with hydrocortisone. There is currently no consensus on appropriate diagnostic feature(s) in veterinary species. THERAPY Low-dose hydrocortisone is the treatment of choice for patients with CIRCI. PROGNOSIS If the patient survives the critical illness, prognosis for resolution of CIRCI and hydrocortisone dependence is very good.
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18
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Bovens C, Tennant K, Reeve J, Murphy KF. Basal serum cortisol concentration as a screening test for hypoadrenocorticism in dogs. J Vet Intern Med 2014; 28:1541-5. [PMID: 25066405 PMCID: PMC4895569 DOI: 10.1111/jvim.12415] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 03/09/2014] [Accepted: 06/17/2014] [Indexed: 11/29/2022] Open
Abstract
Background Measurement of basal serum or plasma cortisol concentration is used as a screening test for hypoadrenocorticism in dogs, but is not well characterized. Objectives To evaluate the sensitivity and specificity of basal serum cortisol to detect hypoadrenocorticism in a population of dogs with a clinical suspicion of hypoadrenocorticism. Animals Four hundred and fifty dogs with nonadrenal gland illness and 14 dogs with naturally occurring hypoadrenocorticism were included. Methods Retrospective case‐control study. The records of all dogs having had an ACTH stimulation test performed between January 2005 and September 2011 at the University of Bristol were reviewed. Dogs were included if the test was performed as a screening for hypoadrenocorticism. The sensitivity and specificity of basal serum cortisol concentration to detect dogs with hypoadrenocorticism were calculated using 2 cut‐offs and compared to the gold standard ACTH stimulation test. Results Using a cut‐off of ≤2 μg/dL (≤55 nmol/L), the sensitivity and specificity of basal cortisol to detect hypoadrenocorticism were 100% and 63.3%, respectively, whereas for a cut‐off of ≤1 μg/dL (≤28 nmol/L), the sensitivity and specificity were 85.7% and 91.8%, respectively. Conclusions and Clinical Importance Measurement of basal serum cortisol is useful as a screening test for hypoadrenocorticism in dogs using a cut‐off of ≤2 μg/dL (≤55 nmol/L), and the disease is unlikely with a basal serum cortisol >2 μg/dL (>55 nmol/L). A basal serum cortisol ≤2 μg/dL (≤55 nmol/L) cannot be used to diagnose hypoadrenocorticism, and an ACTH stimulation test should be performed in these cases.
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Affiliation(s)
- C Bovens
- School of Veterinary Sciences, University of Bristol, Langford, Bristol, UK; Small Animal Hospital, Langford Veterinary Services, Langford, Bristol, UK
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McCandless EE, Rai SK, Mwangi D, Sly L, Franz LC. Hydrocortisone inhibits IFN-γ production in equine, ovine, and bovine PBMCs. Vet Immunol Immunopathol 2013; 153:128-33. [DOI: 10.1016/j.vetimm.2012.12.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 11/29/2012] [Accepted: 12/27/2012] [Indexed: 01/26/2023]
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