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Hobbs KJ, Cooper BL, Dembek K, Sheats MK. Investigation of Extracted Plasma Cell-Free DNA as a Biomarker in Foals with Sepsis. Vet Sci 2024; 11:346. [PMID: 39195800 PMCID: PMC11359113 DOI: 10.3390/vetsci11080346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 07/23/2024] [Accepted: 07/27/2024] [Indexed: 08/29/2024] Open
Abstract
Cell-free DNA (cfDNA) is fragmented extracellular DNA that is released from cells into various body fluids. Previously published data from adult horses supports cfDNA as a potential disease biomarker, but also shows that direct measurement in plasma is inaccurate due to matrix effect. It is currently unknown whether a similar matrix effect exists in foal plasma. Given this, the objectives of the current study were to investigate foal plasma for potential matrix effect during fluorescence measurement of cfDNA using a Qubit fluorometer, and to determine whether neat and/or extracted plasma cfDNA concentrations are significantly different in healthy, sick non-septic (SNS) or septic foals. We hypothesized that matrix effect would interfere with accurate fluorescent measurement of cfDNA in foal plasma. Further, we hypothesized that mean extracted cfDNA concentrations, and/or extracted cfDNA:neutrophil ratio, would be elevated in plasma of septic foals compared to healthy or SNS foals. Cell-free DNA was measured in neat plasma, and following DNA extraction with a commercial kit, from 60 foals. Foal plasma exhibited both autofluorescence and non-specific dye binding, confirming matrix effect. However, even with extraction, no significant difference was found in cfDNA concentrations, or cfDNA:neutrophil ratios, between healthy (sepsis score ≤ 5), SNS (sepsis score 6-11 and negative blood culture), or septic (sepsis score ≥ 12 ± positive blood culture) foals. Our data show that matrix effect interferes with accurate Qubit measurement of cfDNA in foal plasma and supports previous findings that plasma cfDNA concentrations are not associated with sepsis diagnosis in foals. Further research is needed to better understand neutrophil function and dysfunction in foal sepsis.
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Affiliation(s)
| | | | | | - M. Katie Sheats
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC 27695, USA; (K.J.H.); (B.L.C.); (K.D.)
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2
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Siemińska I, Arent Z. What we know about alterations in immune cells during sepsis in veterinary animals? Vet Immunol Immunopathol 2024; 274:110804. [PMID: 39002363 DOI: 10.1016/j.vetimm.2024.110804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 06/30/2024] [Accepted: 07/02/2024] [Indexed: 07/15/2024]
Abstract
Sepsis is still one of the most common causes of death of animals and humans. It is marked by an aberrant immune response to infection, resulting in extensive inflammation, organ dysfunction, and, in severe instances, organ failure. Recognizable symptoms and markers of sepsis encompass substantial elevations in body temperature, respiratory rate, hemoglobin levels, and alterations in immune cell counts, including neutrophils, monocytes, and basophils, along with increases in certain acute-phase proteins. In contrast to human medicine, veterinarians must take into account some species differences. This article provides a comprehensive overview of changes in the immune system during sepsis, placing particular emphasis on species variations and exploring potential future drugs and interventions. Hence, understanding the intricate balance of the immune responses during sepsis is crucial to develop effective treatments and interventions to improve the chances of recovery in animals suffering from this serious condition.
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Affiliation(s)
- Izabela Siemińska
- Center of Experimental and Innovative Medicine, University Centre of Veterinary Medicine JU-UA, University of Agriculture in Krakow, Redzina 1C, Krakow 30-248, Poland.
| | - Zbigniew Arent
- Center of Experimental and Innovative Medicine, University Centre of Veterinary Medicine JU-UA, University of Agriculture in Krakow, Redzina 1C, Krakow 30-248, Poland
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3
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Cummings CO, Krucik DD, Price E. Clinical predictive models in equine medicine: A systematic review. Equine Vet J 2023; 55:573-583. [PMID: 36199162 PMCID: PMC10073351 DOI: 10.1111/evj.13880] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/23/2022] [Indexed: 11/28/2022]
Abstract
Clinical predictive models use a patient's baseline demographic and clinical data to make predictions about patient outcomes and have the potential to aid clinical decision making. The extent of equine clinical predictive models is unknown in the literature. Using PubMed and Google Scholar, we systematically reviewed the predictive models currently described for use in equine patients. Models were eligible for inclusion if they were published in a peer-reviewed article as a multivariable model used to predict a clinical/laboratory/imaging outcome in an individual horse or herd. The agreement of at least two authors was required for model inclusion. We summarised the patient populations, model development methods, performance metric reporting, validation efforts, and, using the Predictive model Risk of Bias Assessment Tool (PROBAST), assessed the risk of bias and applicability concerns for these models. In addition, we summarised the index conditions for which models were developed and provided detailed information on included models. A total of 90 predictive models and 9 external validation studies were included in the final systematic review. A plurality of models (41%) was developed to predict outcomes associated with colic, for example, need for surgery or survival to discharge. All included models were at high risk of bias, defined as failing one or more PROBAST signalling questions, primarily for analysis-related reasons. Importantly, a high risk of bias does not necessarily mean that models are unusable, but that they require more careful consideration prior to clinical use. Concerns about applicability were low for the majority of models. Systematic reviews such as this can serve to increase veterinarians' awareness of predictive models, including evaluation of their performance and their use in different patient populations.
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Affiliation(s)
- Charles O. Cummings
- Tufts Clinical and Translational Science Institute, Tufts
Medical Center, Boston, MA 02111, USA
| | - David D.R. Krucik
- Department of Comparative Medicine, Stanford University,
Stanford, California 94305, USA
| | - Emma Price
- Tufts Clinical and Translational Science Institute, Tufts
Medical Center, Boston, MA 02111, USA
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4
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Dembek K, Timko K, Moore C, Johnson L, Frazer M, Barr B, Toribio R. Longitudinal assessment of adrenocortical steroid and steroid precursor response to illness in hospitalized foals. Domest Anim Endocrinol 2023; 82:106764. [PMID: 36162341 DOI: 10.1016/j.domaniend.2022.106764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 10/14/2022]
Abstract
Sepsis is a major cause of morbidity and mortality in neonatal foals. Relative adrenal insufficiency (RAI), defined as an inadequate cortisol response to stress, has been associated with sepsis, prematurity, and poor outcome in newborn foals. In addition to cortisol, the adrenal gland synthesizes several biologically important steroids and steroid precursors, including aldosterone, androgens, and progestogens. However, concentration of these hormones during hospitalization and their association with the severity of disease and mortality in critically ill foals have not been completely evaluated. We hypothesized, that in addition to cortisol and aldosterone, concentration of steroid precursors (progestogens and androgens) will be altered in critically ill foals. We also proposed that septic foals will have higher concentrations of steroid precursors than healthy foals, and steroid concentrations will be persistently increased during hospitalization in non-surviving septic and premature foals. Foals <4 days of age were categorized as healthy, septic, sick non-septic, and premature based on physical exam, medical history, and laboratory data. Blood samples were collected on admission (0 h), 24 h, and 72 h after admission. Concentrations of steroids and ACTH were measured by immunoassays. The area under the curve over 72 h (AUC0-72h) of hospitalization was calculated for each hormone. Serum cortisol, aldosterone, progesterone, pregnenolone, dehydroepiandrosterone sulfate (DHEAS), and 17 α-hydroxyprogesterone concentrations were higher in septic and premature foals compared to healthy foals at 0 h and throughout 72 h of hospitalization (P < 0.05). Plasma ACTH concentrations were higher in septic and premature foals on admission compared to healthy controls (P < 0.05). The progesterone (AUC0-72h) cut-off value above which non-survival could be reliably predicted in hospitalized foals was 1,085 ng/mL/h, with 82% sensitivity and 77% specificity. Critically ill neonatal foals had an appropriate response to stress characterized by increased concentrations of cortisol and steroid precursors on admission. A rapid decline in steroid concentration was observed in healthy foals. However, persistently elevated progestogen and androgen concentrations were associated with a lack of improvement in the course of disease and poor outcome.
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Affiliation(s)
- K Dembek
- College of Veterinary Medicine, North Carolina State University, Raleigh, NC, USA.
| | - K Timko
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
| | - C Moore
- Jacksonville Equine Associates, Jacksonville, FL, USA
| | - L Johnson
- Fairfield Equine Associates, Newtown, CT, USA
| | - M Frazer
- Hagyard Equine Medical Institute, Lexington, KY, USA
| | - B Barr
- Rood and Riddle Equine Hospital, Lexington, KY, USA
| | - R Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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5
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Hoeberg E, Sånge A, Saegerman C, Bohlin A, Nostell K, Durie I, Husted L, Öhman A, Jacobsen S, Berg L, Laursen SH, van Galen G. Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals. Vet Med (Auckl) 2022; 36:2245-2253. [PMID: 36239317 DOI: 10.1111/jvim.16550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Serum amyloid A (SAA) has been reported to hold promise as diagnostic and prognostic marker in foals. This has not been investigated thoroughly. OBJECTIVES Evaluate admission SAA concentrations as predictor of sepsis and outcome. ANIMALS Five hundred and ninety hospitalized foals <14 days old. METHODS Retrospective multicenter study. Foals were scored with sepsis and survival scores, grouped according to health category (septic, sick but nonseptic, uncertain sepsis status) and outcome; septic foals were further categorized according to severity (normal sepsis, severe sepsis, and septic shock). SAA was compared between groups using Mann-Whitney test and Kruskal-Wallis test. Receiver operating characteristic curves identified optimal SAA cut off values for detecting sepsis and predicting outcome. RESULTS Admission SAA concentrations differed significantly between sick nonseptic foals (312.1 ± 685.4 mg/L) and septic foals (1079.7 ± 1254.5 mg/L) and increased with increasing sepsis score. SAA did not differ between sepsis severity groups. The optimal cut off for sepsis detection was 1050 mg/L (sensitivity 30.2%, specificity 90.7%). Admission SAA concentrations were lower in surviving (435.0 ± 723.6 mg/L) compared to nonsurviving foals (1062.7 ± 1440.1 mg/L) and decreased with increasing survival score. The optimal cut off for nonsurvival prediction was 1250 mg/L (sensitivity 22.1%, specificity 90.8%). CONCLUSIONS AND CLINICAL IMPORTANCE SAA concentration was higher in septic foals and nonsurviving foals. Even though optimal cut offs for SAA to detect sepsis and predict outcome had low sensitivity, they had good specificity. SAA can therefore be used as a marker to rule out sepsis and nonsurvival.
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Affiliation(s)
- Emma Hoeberg
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.,Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway
| | - Alexandra Sånge
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.,Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden
| | - Claude Saegerman
- Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiege), Fundamental and Applied Research for Animal Health (FARAH) Center, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
| | - Anna Bohlin
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden
| | | | - Inge Durie
- Evidensia Equine Specialist Hospital Stromsholm, Stromsholm, Sweden
| | | | - Anna Öhman
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden
| | - Stine Jacobsen
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Lise Berg
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Sigrid Hyldahl Laursen
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.,Equine Medical Consult, Hornbaek, Denmark
| | - Gaby van Galen
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.,Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, Australia
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6
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Kang H, Sole-Guitart A, Mellor VA, Gaughan JB, Zsoldos RR. The use of percutaneous thermal sensing microchips for non-invasive measurement of body temperature in foals during summer seasons in a subtropical region. Animal 2022; 16:100620. [PMID: 35994970 DOI: 10.1016/j.animal.2022.100620] [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: 03/22/2022] [Revised: 07/17/2022] [Accepted: 07/22/2022] [Indexed: 11/28/2022] Open
Abstract
Continuous accurate attainment of the body temperature of foals is important to detect early stages of severe heat stress or fever due to a systemic illness. Among a number of methods to measure body temperature, measuring rectal temperature with a digital thermometer is most frequently used due to being relatively fast and simple method. It is also comparatively accurate and correlates well with the core body temperature. However, this method requires restraining the foal for a few seconds to obtain the temperature, and it can be dangerous for the handling person. Percutaneous thermal sensing microchips (PTSMs) are a means of monitoring the body temperature of horses, which offers a non-invasive, hygienic, quick, and accurate way to measure body temperature and provide an identification number for each individual, once it is implanted. This study tested the hypothesis that PTSM has a strong relationship with a conventional body temperature measurement, i.e., measuring rectal temperature with a digital thermometer of foals during summer seasons. Thirty-two foals in three consecutive foaling seasons (2018, 2019, and 2020 season) were implanted a PTSM into the right pectoral muscle, the right splenius muscle, the right gluteal muscle, and the nuchal ligament as early as two weeks after birth. The four PTSM temperatures, rectal temperature, and climate conditions (air temperature, relative humidity, and wet-bulb globe temperature) were obtained simultaneously during the three summer seasons and paired for comparison analysis. Among the PTSM temperatures, the pectoral muscle had the highest correlation and the least differences with rectal temperature. Using PTSM was safe, easy, and reliable for attaining body temperature in foals.
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Affiliation(s)
- H Kang
- School of Agriculture and Food Sciences, The University of Queensland, Gatton 4343, Australia.
| | - A Sole-Guitart
- School of Veterinary Science, The University of Queensland, Gatton 4343, Australia
| | - V A Mellor
- School of Agriculture and Food Sciences, The University of Queensland, Gatton 4343, Australia
| | - J B Gaughan
- School of Agriculture and Food Sciences, The University of Queensland, Gatton 4343, Australia
| | - R R Zsoldos
- School of Agriculture and Food Sciences, The University of Queensland, Gatton 4343, Australia
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7
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Abstract
BACKGROUND Prediction modelling can greatly assist the health-care professionals in the management of diseases, thus sparking interest in neonatal sepsis diagnosis. The main objective of the study was to provide a complete picture of performance of prediction models for early detection of neonatal sepsis. METHODS PubMed, Scopus, CINAHL databases were searched and articles which used various prediction modelling measures for the early detection of neonatal sepsis were comprehended. Data extraction was carried out based on Critical Appraisal and Data Extraction for Systematic Reviews of Prediction Modelling Studies checklist. Extricate data consisted of objective, study design, patient characteristics, type of statistical model, predictors, outcome, sample size and location. Prediction model Risk of Bias Assessment Tool was applied to gauge the risk of bias of the articles. RESULTS An aggregate of ten studies were included in the review among which eight studies had applied logistic regression to build a prediction model, while the remaining two had applied artificial intelligence. Potential predictors like neonatal fever, birth weight, foetal morbidity and gender, cervicovaginitis and maternal age were identified for the early detection of neonatal sepsis. Moreover, birth weight, endotracheal intubation, thyroid hypofunction and umbilical venous catheter were promising factors for predicting late-onset sepsis; while gestational age, intrapartum temperature and antibiotics treatment were utilised as budding prognosticators for early-onset sepsis detection. CONCLUSION Prediction modelling approaches were able to recognise promising maternal, neonatal and laboratory predictors in the rapid detection of early and late neonatal sepsis and thus, can be considered as a novel way for clinician decision-making towards the disease diagnosis if not used alone, in the years to come.
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8
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Wong DM, Young L, Dembek KA. Blood thiamine (vitamin B 1 ), ascorbic acid (vitamin C), and cortisol concentrations in healthy and ill neonatal foals. J Vet Intern Med 2021; 35:1988-1994. [PMID: 34056771 PMCID: PMC8295700 DOI: 10.1111/jvim.16188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/05/2021] [Accepted: 05/17/2021] [Indexed: 12/20/2022] Open
Abstract
Background Sepsis is common in foals and several treatments are used to facilitate recovery. Evidence in people suggests an association between low blood concentrations of thiamine, ascorbic acid, and cortisol and sepsis, with further evidence suggesting that administration of hydrocortisone, thiamine, and ascorbic acid may improve outcome. No information is available with regard to these treatments in foals. Hypothesis/Objectives To compare blood concentrations of thiamine, ascorbic acid, and cortisol in healthy and ill foals. Animals Fifteen healthy and 27 ill (septic and sick‐nonseptic [SNS]) foals were evaluated at admission. Fewer healthy and ill foals were available for sampling at 72 and 120 hours. Methods Prospective study. Blood was collected from healthy foals at 12 (n = 15), 72 (n = 11), and 120 (n = 9) hours of age and from ill foals <48 hours old at admission (n = 27), 72 (n = 8), and 120 (n = 8) hours after presentation. Thiamine, ascorbic acid, and cortisol concentrations were measured in blood samples and compared between groups of foals. Results Blood concentrations of thiamine were significantly lower in septic compared to healthy foals at 72 (median, 1.72 ng/mL; P = .02) and 120 (median, 2.0 ng/mL; P = .04) hours after admission; blood concentrations of ascorbic acid also were significantly lower in septic compared to healthy foals at 72 (median, 4.4 μg/mL; P = .02) and 120 hours (median, 4.8 μg/mL; P = .03). Blood concentrations of ascorbic acid were lower in SNS compared to healthy foals at 72 (median, 6.9 μg/mL; P = .03) and 120 (median, 6.4 μg/mL; P = .04) hours after admission. Serum cortisol concentrations were significantly higher at admission in septic (median, 4.23 μg/dL) compared to SNS (median, 1.8 μg/dL; P = .01) and healthy (median, 2.2 μg/dL; P = .002) foals. Conclusions and Clinical Importance A potential association exists between illness in foals and lower blood concentrations of thiamine and ascorbic acid during hospitalization. Additional studies are needed to examine a larger population of foals and determine the clinical impact of low vitamin concentrations, if any, on morbidity and mortality.
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Affiliation(s)
- David M Wong
- Lloyd Veterinary Medical Center, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | | | - Katarzyna A Dembek
- North Carolina State University, College of Veterinary Medicine, Raleigh, NC, USA
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9
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Causes of equine perinatal mortality. Vet J 2021; 273:105675. [PMID: 34148598 DOI: 10.1016/j.tvjl.2021.105675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 03/24/2021] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
The peripartum period is critical in equine medicine for maintaining healthy mares, and ensuring the delivery of healthy neonatal foals. The field of perinatal mortality in horses is continuously evolving, with several advances being recently made in causes of perinatal fetal and foal loss. This review details the main causes of perinatal loss in horses, through late pregnancy, parturition and the neonatal period. Recent advances in identification of infectious organisms and indicators of survival in neonatal foals will be discussed. Continued advances in reproductive and neonatal medicine will aid improved survival of foals through fewer pregnancy losses, and improved management of high-risk pregnancies and critically ill neonatal foals.
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10
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Lawson A, Pinchbeck G. Study design synopsis: Observational study design in equine research. Equine Vet J 2021; 53:638-644. [PMID: 33719094 DOI: 10.1111/evj.13427] [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: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/27/2022]
Abstract
When planning to conduct research, thorough consideration of the study design is essential to enable valid results and purposeful conclusions. A good study design will provide a strong basis for robust conclusions that can contribute to the evidence base. Conversely, a poor study design may unintentionally lead to invalid conclusions with inappropriate claims of the clinical importance. The purpose of this article is to review important aspects of observational study design, with an emphasis on observational clinical research. The value of an observational study can be manifold and the benefit of studying clinical cases can add substantial value to the evidence base and equine health and welfare, however this value will be diminished if study designs are flawed, or are inadequately reported. It is essential that clinicians have the skills to critically appraise observational studies, to determine strengths, limitations and the applicability to their clinical practice.
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Affiliation(s)
- April Lawson
- Faculty of Health and Life Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst, Neston, Cheshire, UK
| | - Gina Pinchbeck
- Faculty of Health and Life Sciences, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Leahurst, Neston, Cheshire, UK
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11
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Valverde A. Fluid Resuscitation for Refractory Hypotension. Front Vet Sci 2021; 8:621696. [PMID: 33778035 PMCID: PMC7987676 DOI: 10.3389/fvets.2021.621696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/01/2021] [Indexed: 12/22/2022] Open
Abstract
Hypotension is a common occurrence, especially in anesthetized patients and in critical patients suffering from hypovolemia due to shock and sepsis. Hypotension can also occur in normovolemic animals, anesthetized or conscious, under conditions of vasodilation or decreased cardiac function. The main consequence of hypotension is decreased organ perfusion and tissue injury/dysfunction. In the human literature there is no consensus on what is the threshold value for hypotension, and ranges from < 80 to < 100 mmHg for systolic blood pressure and from < 50 to < 70 mmHg for mean arterial blood pressure have been referenced for intraoperative hypotension. In veterinary medicine, similar values are referenced, despite marked differences in normal arterial blood pressure between species and with respect to humans. Therapeutic intervention involves fluid therapy to normalize volemia and use of sympathomimetics to enhance cardiac function and regulate peripheral vascular resistance. Despite these therapeutic measures, there is a subset of patients that are seemingly refractory and exhibit persistent hypotension. This review covers the physiological aspects that govern arterial blood pressure control and blood flow to tissues/organs, the pathophysiological mechanisms involved in hypotension and refractory hypotension, and therapeutic considerations and expectations that include proper interpretation of cardiovascular parameters, fluid recommendations and therapy rates, use of sympathomimetics and vasopressors, and newer approaches derived from the human literature.
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Affiliation(s)
- Alexander Valverde
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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12
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Swink JM, Rings LM, Snyder HA, McAuley RC, Burns TA, Dembek KA, Gilsenan WF, Browne N, Toribio RE. Dynamics of androgens in healthy and hospitalized newborn foals. J Vet Intern Med 2020; 35:538-549. [PMID: 33277956 PMCID: PMC7848305 DOI: 10.1111/jvim.15974] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 01/25/2023] Open
Abstract
Background Information on steroids derived from the adrenal glands, gonads, or fetoplacental unit is minimal in newborn foals. Objective To measure androgen concentrations in serum and determine their association with disease severity and outcome in hospitalized foals. Animals Hospitalized (n = 145) and healthy (n = 80) foals. Methods Prospective, multicenter, cross‐sectional study. Foals of ≤3 days of age from 3 hospitals and horse farms were classified as healthy and hospitalized (septic, sick nonseptic, neonatal maladjustment syndrome [NMS]) based on physical exam, medical history, and laboratory findings. Serum androgen and plasma ACTH concentrations were measured with immunoassays. Data were analyzed by nonparametric methods and univariate analysis. Results Serum dehydroepiandrosterone (DHEA), androstenedione, testosterone, and dihydrotestosterone (DHT) concentrations were higher upon admission in hospitalized foals (P < .05), were associated with nonsurvival, decreased to 4.9‐10.8%, 5.7‐31%, and 30.8‐62.8% admission values in healthy, SNS, and septic foals, respectively (P < .05), but remained unchanged or increased in nonsurviving foals. ACTH:androgen ratios were higher in septic and NMS foals (P < .05). Foals with decreased androgen clearance were more likely to die (odds ratio > 3; P < .05). Conclusions and Clinical Importance Similar to glucocorticoids, mineralocorticoids, and progestagens, increased serum concentrations of androgens are associated with disease severity and adverse outcome in hospitalized newborn foals. In healthy foals, androgens decrease over time, however, remain elevated longer in septic and nonsurviving foals. Androgens could play a role in or reflect a response to disorders such as sepsis or NMS in newborn foals.
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Affiliation(s)
- Jacob M Swink
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Lindsey M Rings
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA.,Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - Hailey A Snyder
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Rachel C McAuley
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Teresa A Burns
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Katarzyna A Dembek
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA
| | | | - Nimet Browne
- Hagyard Equine Medical Institute, Lexington, Kentucky, USA
| | - Ramiro E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
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13
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Fletcher JR, Bertin FR, Owen H, Fraser NS, Rose AM, Stewart AJ. Oxytetracycline associated acute kidney injury in a neonatal foal. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- J. R. Fletcher
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - F. R. Bertin
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - H. Owen
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - N. S. Fraser
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - A. M. Rose
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
| | - A. J. Stewart
- School of Veterinary Science The University of Queensland Gatton Queensland Australia
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14
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Furr M, McKenzie H. Factors associated with the risk of positive blood culture in neonatal foals presented to a referral center (2000-2014). J Vet Intern Med 2020; 34:2738-2750. [PMID: 33044020 PMCID: PMC7694804 DOI: 10.1111/jvim.15923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
Background Bloodstream infections (BSI) are common in sick foals and increase foal morbidity and mortality when they occur. Recognition of risk factors for BSI could be an important means to limit their occurrence, but studies on this topic are limited. Objectives Historical as well as maternal and foal physical examination findings will predict risk of BSI in neonatal foals. Animals Foals <14 days of age admitted to a referral equine hospital for care. Methods Retrospective case‐control study with univariate and multivariable logistic regression analysis. Results Four hundred twenty‐nine (143 cases and 286 controls) foals <14 days of age were studied. Risk of a foal having a BSI was increased in foals with umbilical disease (adjusted odds ratio [OR], 11.01; P = .02), hypoglycemia (adjusted OR, 13.51; P = .03), and the combined presence of umbilical disease and low hematocrit (adjusted OR, >999.99; P = .04). Factors not found to be risk factors for development of BSI included prematurity, hypothermia, abdominal disease, diarrhea, failure of passive transfer, and maternal uterine infection. Conclusions and Clinical Importance Several historical and physical examination findings increase the risk of foals being blood culture positive at presentation to the hospital. This knowledge may aid early identification of blood culture status, thus aiding in treatment decisions.
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Affiliation(s)
- Martin Furr
- College of Veterinary Medicine, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Harold McKenzie
- Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia, USA
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Yang J, Ma Y, Mao M, Zhang P, Gao H. Application of regression model combined with computer technology in the construction of early warning model of sepsis infection in children. J Infect Public Health 2019; 13:253-259. [PMID: 31818709 DOI: 10.1016/j.jiph.2019.11.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/14/2019] [Accepted: 11/25/2019] [Indexed: 12/11/2022] Open
Abstract
This paper uses computer technology combined with regression model to analyze the risk factors of children with sepsis, determine the relevant factors and establish a corresponding early warning model of sepsis, and then verify the clinical application value of the regression model. The paper collected severe infections and sepsis in children who came to our hospital from 2014 to 2018, including 129 patients with infection and 86 patients with sepsis. The general conditions, clinical symptoms, laboratory tests and other factors were used. Analysis, to identify the risk of infection development into sepsis, and use Logistic regression model combined with computer technology to construct an early warning model of sepsis. The experimental results show that early warning of sepsis is closely related to skin spots, platelets, procalcitonin, creatinine and international normalized ratio. The experiment demonstrates that the early warning model has higher sensitivity and specificity, and has higher accuracy for predicting whether infection develops into sepsis in advance, and has certain clinical value.
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Affiliation(s)
- Jing Yang
- Department of Pediatric, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, China.
| | - Yujie Ma
- Department of Pediatric, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, China
| | - Min Mao
- Department of Pediatric, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, China
| | - Pingli Zhang
- Department of Pediatric, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, China
| | - Huixiang Gao
- Department of Pediatric, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266035, Shandong, China
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Sheats MK. A Comparative Review of Equine SIRS, Sepsis, and Neutrophils. Front Vet Sci 2019; 6:69. [PMID: 30931316 PMCID: PMC6424004 DOI: 10.3389/fvets.2019.00069] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 02/15/2019] [Indexed: 12/15/2022] Open
Abstract
The most recent definition of sepsis in human medicine can be summarized as organ dysfunction caused by a dysregulated host response to infection. In equine medicine, although no consensus definition is available, sepsis is commonly described as a dysregulated host systemic inflammatory response to infection. Defense against host infection is the primary role of innate immune cells known as neutrophils. Neutrophils also contribute to host injury during sepsis, making them important potential targets for sepsis prevention, diagnosis, and treatment. This review will present both historical and updated perspectives on the systemic inflammatory response (SIRS) and sepsis; it will also discuss the impact of sepsis on neutrophils, and the impact of neutrophils during sepsis. Future identification of clinically relevant sepsis diagnosis and therapy depends on a more thorough understanding of disease pathogenesis across species. To gain this understanding, there is a critical need for research that utilizes a clearly defined, and consistently applied, classification system for patients diagnosed with, and at risk of developing, sepsis.
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Affiliation(s)
- M. Katie Sheats
- Department of Clinical Sciences, North Carolina State University College of Veterinary Medicine, Raleigh, NC, United States
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du Preez S, Hughes KJ. Thrombocytopenia, neutropenia, ulcerative dermatitis and haemarthrosis in a neonatal foal. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12737] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- S. du Preez
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - K. J. Hughes
- School of Animal and Veterinary Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
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18
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Haspeslagh M, Gerber V, Knottenbelt D, Schüpbach G, Martens A, Koch C. The clinical diagnosis of equine sarcoids—Part 2: Assessment of case features typical of equine sarcoids and validation of a diagnostic protocol to guide equine clinicians in the diagnosis of equine sarcoids. Vet J 2018; 240:14-18. [DOI: 10.1016/j.tvjl.2018.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 07/05/2018] [Accepted: 08/31/2018] [Indexed: 12/01/2022]
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19
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Wilkins PA. What's in a word? The need for SIRS and sepsis definitions in equine medicine and surgery. Equine Vet J 2018; 50:7-9. [PMID: 29193295 DOI: 10.1111/evj.12780] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- P A Wilkins
- University of Illinois - Veterinary Clinical Sciences, Champain-Urbana, Illinois, USA
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20
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Kamr AM, Dembek KA, Hildreth BE, Morresey PR, Rathgeber RA, Burns TA, Zaghawa AA, Toribio RE. The FGF-23/klotho axis and its relationship with phosphorus, calcium, vitamin D, PTH, aldosterone, severity of disease, and outcome in hospitalised foals. Equine Vet J 2018; 50:739-746. [PMID: 29660161 DOI: 10.1111/evj.12946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/30/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Fibroblast growth factor-23 (FGF-23) and klotho are key regulators of vitamin D and parathyroid hormone (PTH) synthesis as well as phosphorus and calcium homeostasis; however, information on the FGF-23/klotho axis in healthy and hospitalised foals is lacking. OBJECTIVES The aims of this study were to measure serum FGF-23 and klotho concentrations and determine their association with serum phosphorus, total calcium (TCa), vitamin D metabolite [25(OH)D, 1,25(OH)2 D], PTH, and aldosterone concentrations, disease severity, and mortality in hospitalised foals. STUDY DESIGN Prospective, multicentre, cross-sectional study. METHODS A total of 91 foals ≤72 h old were classified as hospitalised (n = 81; 58 septic; 23 sick non-septic [SNS]) and healthy (n = 10). Blood samples were collected on admission. Hormone concentrations were determined by immunoassays. RESULTS Serum FGF-23, PTH, phosphorus, and aldosterone concentrations were higher while klotho, 25(OH)D, 1,25(OH)2 D, and TCa concentrations were lower in septic and SNS compared to healthy foals (P<0.05). In hospitalised and septic foals, increased FGF-23 and aldosterone concentrations were associated with high phosphorus and PTH but not with TCa and vitamin D metabolite concentrations. Hospitalised foals with the highest FGF-23 and lowest klotho concentrations were more likely to die (odds ratio (OR): 3.3; 95% confidence interval (CI): 1.1-10.3 and OR: 3.1; CI: 1.1-8.0, respectively). MAIN LIMITATIONS Blood gas, ionised calcium, blood culture information not being available for many foals, and use of the sepsis score to classify hospitalised foals. CONCLUSIONS Imbalances in the FGF-23/klotho axis may contribute to mineral dyshomeostasis and disease progression in critically ill foals. Elevated FGF-23 and reduced klotho, together with high phosphorus and PTH concentrations suggests FGF-23 resistance. FGF-23 and klotho are good markers of disease severity and likelihood of mortality in hospitalised foals. Aldosterone may influence phosphorus and PTH dynamics in hospitalised foals. Routine measurement of phosphorus concentrations in sick foals is recommended.
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Affiliation(s)
- A M Kamr
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA.,Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - K A Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - B E Hildreth
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - P R Morresey
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - R A Rathgeber
- Hagyard Equine Medical Institute, Lexington, Kentucky, USA
| | - T A Burns
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - A A Zaghawa
- Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
| | - R E Toribio
- Faculty of Veterinary Medicine, University of Sadat City, Sadat City, Egypt
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21
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Wong DM, Ruby RE, Dembek KA, Barr BS, Reuss SM, Magdesian KG, Olsen E, Burns T, Slovis NM, Wilkins PA. Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates. J Vet Intern Med 2018; 32:1185-1193. [PMID: 29582480 PMCID: PMC5980351 DOI: 10.1111/jvim.15087] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 12/18/2017] [Accepted: 01/31/2018] [Indexed: 01/09/2023] Open
Abstract
Background The original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated. Objectives To evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals. Animals Two‐hundred and seventy‐three ill foals and 25 healthy control foals. Methods Historical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis. Results One‐hundred and twenty‐six foals were septic and 147 sick‐nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick‐nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One‐hundred and twenty‐seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study. Conclusions and Clinical Importance The updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.
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Affiliation(s)
- D M Wong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa
| | - R E Ruby
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa
| | - K A Dembek
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Lloyd Veterinary Medical Center, Iowa State University, Ames, Iowa
| | - B S Barr
- Department of Internal Medicine, Rood and Riddle Equine Hospital, Lexington, Kentucky
| | - S M Reuss
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - K G Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, California
| | - E Olsen
- Department of Clinical Sciences, New York State College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - T Burns
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio
| | - N M Slovis
- McGee Medicine Center, Hagyard Equine Medical Institute, Lexington, Kentucky
| | - P A Wilkins
- Department of Veterinary Clinical Medicine, University of Illinois, Urbana, Illinois
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22
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Austin SM. Management and treatment of the sick equine neonate in ambulatory practice. EQUINE VET EDUC 2018. [DOI: 10.1111/eve.12584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- S. M. Austin
- Department of Veterinary Clinical Medicine; University of Illinois at Urbana-Champaign; Urbana Illinois USA
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23
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Lauteri E, Corsalini J, Pepe M, Mandara MT, Passamonti F, Beccati F. EHV-1 Congenital Infection and Concurrent Actinobacillus equuli Septicemia in a Standardbred Neonatal Foal: Clinical, Diagnostic Findings, and Evaluation of Adrenal Gland Function. J Equine Vet Sci 2018. [DOI: 10.1016/j.jevs.2017.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Berryhill EH, Magdesian KG, Kass PH, Edman JE. Triglyceride concentrations in neonatal foals: Serial measurement and effects of age and illness. Vet J 2017; 227:23-29. [PMID: 29031326 DOI: 10.1016/j.tvjl.2017.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 07/31/2017] [Accepted: 08/04/2017] [Indexed: 11/29/2022]
Abstract
Few studies have evaluated the effects of age and illness on serum triglyceride concentrations in neonatal foals. The objectives of this study were to evaluate triglyceride concentrations in neonatal foals and their dams through serial measurement immediately postpartum and at 1-2 days and 10-12 days of age, as well as to measure them in sick foals. Serially measured serum triglycerides in seven healthy foals varied with age. Median (range) triglyceride concentrations were 28mg/dL (12-50mg/dL), 89mg/dL (51-264mg/dL), and 60mg/dL (28-135mg/dL) immediately postpartum, at 1-2 days of age, and 10-12 days of age, respectively (P<0.001). Triglyceride concentrations varied hourly by up to 117mg/dL in individual foals. The dams had lower triglycerides (median, 20mg/dL; range, 12-49mg/dL) than the foals, once foals were >24h old. Sick foals <24h old had lower triglycerides than sick foals aged 1-7 days (median, 41mg/dL [range, 16-116]; median, 110mg/dL [range, 24-379mg/dL]; P<0.001). Age and triglyceride concentration showed a non-linear association independent of foal health status (P=0.01). Sick foals with positive bacterial cultures had higher triglycerides than those with negative cultures (median, 111mg/dL [range, 10-379mg/dL] and median 53mg/dL [range, 17-271mg/dL], respectively; P=0.033). Nonsurvivors had higher triglycerides than survivors (median, 116mg/dL [range, 41-379mg/dL] and median, 55mg/dL [range, 10-311mg/dL], respectively; P=0.04). In conclusion, triglycerides were highest in healthy neonatal foals aged 1-2 days, and in nonsurviving sick foals and those with positive bacterial cultures. Age was associated with triglyceride concentration regardless of health status.
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Affiliation(s)
- E H Berryhill
- William R. Pritchard Veterinary Medical Teaching Hospital, University of California, Davis, One Garrod Dr., Davis, CA, 95616, USA
| | - K G Magdesian
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave., Davis, CA, 9516, USA.
| | - P H Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, One Shields Ave., Davis, CA, 95616, USA
| | - J E Edman
- Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California, Davis, One Shields Ave., Davis, CA, 9516, USA
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26
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Dembek KA, Timko KJ, Johnson LM, Hart KA, Barr BS, David B, Burns TA, Toribio RE. Steroids, steroid precursors, and neuroactive steroids in critically ill equine neonates. Vet J 2017; 225:42-49. [PMID: 28720298 DOI: 10.1016/j.tvjl.2017.05.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 04/27/2017] [Accepted: 05/19/2017] [Indexed: 12/30/2022]
Abstract
Hypothalamic-pituitary-adrenal axis (HPAA) dysfunction has been associated with sepsis and mortality in foals. Most studies have focused on cortisol, while other steroids have not been investigated. The objectives of this study were to characterise the adrenal steroid and steroid precursor response to disease and to determine their association with the HPAA response to illness, disease severity, and mortality in hospitalised foals. All foals (n=326) were classified by two scoring systems into three categories: based on the sepsis score (septic, sick non-septic [SNS] and healthy) and the foal survival score (Group 1: 3-18%; Group 2: 38-62%; Group 3: 82-97% likelihood of survival). Blood concentrations of adrenocorticotropic hormone (ACTH) and steroids were determined by immunoassays. ACTH-cortisol imbalance (ACI) was defined as a high ACTH/cortisol ratio. Septic foals had higher ACTH, cortisol, progesterone, 17α-OH-progesterone, pregnenolone, and androstenedione concentrations as well as higher ACTH/cortisol, ACTH/progesterone, ACTH/aldosterone, and ACTH/DHEAS ratios than SNS and healthy foals (P<0.01). Foals with DHEAS of 0.4-5.4ng/mL were more likely to have ACI (OR=2.5). Foals in Group 1 had higher ACTH, aldosterone, progesterone, and cortisol concentrations as well as ACTH/cortisol, ACTH/progesterone, and ACTH/DHEAS ratios than foals in Groups 2 and 3 (P<0.01). High progesterone concentrations were associated with non-survival and the cutoff value below which survival could be predicted was 23.5ng/mL, with 75% sensitivity and 72% specificity. In addition to cortisol, the response to the stress of illness in foals is characterised by the release of multiple adrenal steroids. DHEAS and progesterone were good predictors of HPAA dysfunction and outcome in hospitalised foals.
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Affiliation(s)
- K A Dembek
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - K J Timko
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - L M Johnson
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - K A Hart
- College of Veterinary Medicine, University of Georgia, 501 D.W. Brooks Drive, Athens, GA 30602, USA
| | - B S Barr
- Rood and Riddle Equine Hospital, 2150 Georgetown Rd, Lexington, KY 40511, USA
| | - B David
- Hagyard Equine Medical Institute, 4250 Iron Works Pike, Lexington, KY 40511, USA
| | - T A Burns
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA
| | - R E Toribio
- College of Veterinary Medicine, The Ohio State University, 601 Vernon Tharp St., Columbus, OH 43210, USA.
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Harrison JME, Quanstrom LM, Robinson AR, Wobeser B, Anderson SL, Singh B. Expression of von Willebrand factor, pulmonary intravascular macrophages, and Toll-like receptors in lungs of septic foals. J Vet Sci 2017; 18:17-23. [PMID: 27297419 PMCID: PMC5366298 DOI: 10.4142/jvs.2017.18.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/02/2016] [Accepted: 05/12/2016] [Indexed: 01/19/2023] Open
Abstract
Sepsis causes significant mortality in neonatal foals; however, there is little data describing the cellular and molecular pathways of lung inflammation in septic foals. This study was conducted to characterize lung inflammation in septic foals. Lung tissue sections from control (n = 6) and septic (n = 17) foals were compared using histology and immunohistology. Blinded pathologic scoring of hematoxylin and eosin stained samples revealed increased features of lung inflammation such as thickened alveolar septa and sequestered inflammatory cells in septic foals. Septic foal lungs showed increased expression of von Willebrand factor in blood vessels, demonstrating vascular inflammation. Use of MAC387 antibody to detect calprotectin as a reflection of mononuclear cell infiltration revealed a significant increase in their numbers in alveolar septa of lungs from septic foals compared to those from control foals. The mononuclear cells appeared to be mature macrophages and were located in the septal capillaries, suggesting they were pulmonary intravascular macrophages (PIMs). Finally, lungs from septic foals showed increased expression of Toll-like receptor 4 and 9 in mononuclear cells relative to the control. Taken together, this study is the first to show the expression of inflammatory molecules and an increase in PIMs in lungs from foals that died from sepsis.
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Affiliation(s)
- Jacqueline M E Harrison
- Department of Veterinary Biomedical Sciences Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Leah M Quanstrom
- Department of Veterinary Biomedical Sciences Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Alex R Robinson
- Department of Veterinary Biomedical Sciences Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Bruce Wobeser
- Department of Veterinary Pathology, Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Stacy L Anderson
- Department of Veterinary Biomedical Sciences Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Baljit Singh
- Department of Veterinary Biomedical Sciences Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
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Perinatal Diseases. Vet Med (Auckl) 2017. [PMCID: PMC7150149 DOI: 10.1016/b978-0-7020-5246-0.00019-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Sepsis and septic shock represent a major cause of morbidity and mortality in equine neonates and in all species. Early recognition of the condition is important, but definitive examination and laboratory variables to predict equine neonatal sepsis are lacking. Early and aggressive treatment should include broad-spectrum antimicrobial coverage, source control, and hemodynamic support. Field practitioners and intensive care clinicians work together in the management of this condition because the recognition and initial treatment should begin as early as possible.
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Pusterla N, Hall TL, Wetzlich SE, Monmaney G, Collier JR, Hill JA, Tell LA. Pharmacokinetic parameters for single- and multi-dose regimens for subcutaneous administration of a high-dose ceftiofur crystalline-free acid to neonatal foals. J Vet Pharmacol Ther 2016; 40:88-91. [DOI: 10.1111/jvp.12327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
- N. Pusterla
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
| | - T. L. Hall
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
| | - S. E. Wetzlich
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
| | - G. Monmaney
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
| | - J. R. Collier
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
| | - J. A. Hill
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
| | - L. A. Tell
- Department of Medicine and Epidemiology; School of Veterinary Medicine; University of California; Davis CA USA
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31
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Giguère S, Weber EJ, Sanchez LC. Factors associated with outcome and gradual improvement in survival over time in 1065 equine neonates admitted to an intensive care unit. Equine Vet J 2015; 49:45-50. [PMID: 26538009 DOI: 10.1111/evj.12536] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/19/2015] [Indexed: 01/12/2023]
Abstract
REASONS FOR PERFORMING STUDY There is a paucity of information regarding the association between common disorders and outcome over time in a large population of ill equine neonates. OBJECTIVES To describe the relative frequency of neonatal disorders in a large population of foals admitted to a neonatal intensive care unit, to determine the disorders and factors associated with nonsurvival and determine if the outcome of ill neonatal foals has improved over time. STUDY DESIGN Retrospective study. METHODS Cases were selected from equine neonatal (≤14 days of age) admissions between 1982 and 2008. Multivariable logistic regression was used to identify the disorders, clinical parameters and laboratory variables associated with nonsurvival or natural death and assess survival over time after accounting for potential confounding variables. RESULTS A total of 1065 foals were included in the study. Overall, 775 of 1065 (72.8%) foals survived to be discharged from the hospital and 290 (27.2%) foals were nonsurvivors. Age at admission, sepsis score, proportion of foals with positive blood cultures and proportion of survivors were significantly different (P<0.001) between primary disease categories. Variables retained in the multivariable model for nonsurvival included positive blood culture, neutrophils <2.28 × 109 /l, temperature ≤37.6°C, bicarbonate, PCO2 , presence of infectious orthopaedic disorders and sepsis score. The adjusted odds of survival for foals admitted in the 2000s were approximately 3.4 (95% CI = 1.9-6.0, P<0.001) times higher than that of foals admitted in the 1980s. CONCLUSIONS Primary disorders, sepsis, temperature, acid base status and neutropenia are the main factors that affect outcome in this population of equine neonates. The survival of foals admitted to a neonatal intensive care unit has increased dramatically over a 26 year period.
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Affiliation(s)
- S Giguère
- Veterinary Medical Center, University of Georgia, Athens, USA
| | - E J Weber
- Hofmann Neonatal Intensive Care Unit, College of Veterinary Medicine, University of Florida, Gainesville, USA
| | - L C Sanchez
- Hofmann Neonatal Intensive Care Unit, College of Veterinary Medicine, University of Florida, Gainesville, USA
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Zabrecky KA, Slovis NM, Constable PD, Taylor SD. Plasma C-reactive protein and haptoglobin concentrations in critically ill neonatal foals. J Vet Intern Med 2015; 29:673-7. [PMID: 25818221 PMCID: PMC4895508 DOI: 10.1111/jvim.12568] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/31/2014] [Accepted: 02/03/2015] [Indexed: 12/27/2022] Open
Abstract
Background Accurate diagnostic markers for sepsis in neonatal foals are needed. Plasma C‐reactive protein concentration (p[CRP]) and haptoglobin concentration (p[Hp]) are well‐established biomarkers of infection in humans, but studies are lacking in foals. Hypotheses p[CRP]) and p[Hp] are increased in septic foals compared to sick nonseptic and healthy control foals, and are predictive of survival. Animals Eighty critically ill foals (40 septic, 40 sick nonseptic) and 39 healthy control foals <1 week of age. Methods Multicenter, prospective observational clinical study. Venous blood was collected at admission from septic and sick nonseptic foals and from clinically healthy foals at 24 h of age. A diagnosis of sepsis was made based on positive blood culture or a sepsis score >11, and p[CRP] and p[Hp] were measured by using ELISA tests. Data were analyzed by using the Mann‐Whitney U‐test and forward stepwise multivariable linear regression. P < .05 was considered significant. Results Plasma [CRP] was positively associated with age, serum globulin, adrenomedullin, and bilirubin concentrations, aspartate aminotransferase activity, glutamyl‐transferase activity, band neutrophil count, and rectal temperature, and was increased in foals with toxic neutrophils, enterocolitis, colic, rib fractures and septic arthritis. Surprisingly, p[Hp] was lower in septic foals than in sick nonseptic foals. Neither p[CRP] or p[Hp] was predictive of survival in critically ill foals. Conclusions and Clinical Importance Plasma [CRP] increases with inflammation in neonatal foals but is not indicative of sepsis. Single time point, admission sampling of p[CRP] and p[Hp] do not appear to be useful biomarkers for sepsis in foals.
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Affiliation(s)
- K A Zabrecky
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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Liepman RS, Dembek KA, Slovis NM, Reed SM, Toribio RE. Validation of IgG cut-off values and their association with survival in neonatal foals. Equine Vet J 2015; 47:526-30. [PMID: 25683641 DOI: 10.1111/evj.12428] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/09/2015] [Indexed: 11/27/2022]
Abstract
REASONS FOR PERFORMING STUDY Serum immunoglobulin (IgG) assessment in neonatal foals is considered standard care in equine hospitals to determine immunity and overall health. However, cut-off values of IgG to predict complete or partial failure of transfer of passive immunity (FTPI) were developed 30 years ago and are largely empirical with little prospective or statistical data to support their use or association with outcome. OBJECTIVES To critically evaluate the traditional cut-off values of IgG in the assessment of FTPI (IgG < 8 g/l), determine the association between various degrees of FTPI and likelihood of nonsurvival and examine whether FTPI can be predicted by serum total protein (TP), albumin and globulin in hospitalised foals. STUDY DESIGN Multicentre, cross-sectional study. METHODS We evaluated clinicopathological variables in 597 foals ≤ 7 days old from 3 equine hospitals including serum IgG, fibrinogen, TP and albumin concentrations. Foals were divided into 3 groups by diagnosis: healthy, sick nonseptic and septic. The aforementioned variables in addition to globulin concentrations were evaluated in a subset of 118 foals. Univariate, multivariate and multinomial logistic regression were used to compute odds ratios for nonsurvival in these foals. RESULTS Our findings support use of the traditional cut-off value of > 8 g/l as adequate transfer of passive immunity (ATPI). Odds of nonsurvival increased in proportion to lower IgG concentrations. Higher TP concentrations were associated with lower likelihood of FTPI; however, higher albumin concentrations were associated with a greater likelihood of FTPI. A regression equation was created to predict IgG in foals using serum proteins. CONCLUSIONS Serum IgG values of <8 g/l in hospitalised foals were proportionally associated with mortality. We recommend immediate assessment of IgG concentrations in hospitalised foals and those with FTPI should receive prompt immunotherapy. The summary is available in Chinese - see Supporting information.
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Affiliation(s)
- R S Liepman
- Department of Veterinary Clinical Sciences, The Ohio State University, USA
| | - K A Dembek
- Department of Veterinary Clinical Sciences, The Ohio State University, USA
| | - N M Slovis
- Hagyard Equine Medical Institute, Lexington, Kentucky, USA
| | - S M Reed
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - R E Toribio
- Department of Veterinary Clinical Sciences, The Ohio State University, USA
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Dembek KA, Hurcombe SD, Stewart AJ, Barr BS, MacGillivray KC, Kinee M, Elam J, Toribio RE. Association of aldosterone and arginine vasopressin concentrations and clinical markers of hypoperfusion in neonatal foals. Equine Vet J 2015; 48:176-81. [PMID: 25421257 DOI: 10.1111/evj.12393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
Abstract
REASONS FOR PERFORMING STUDY Critically ill foals often present to veterinary hospitals with impaired organ perfusion which can be demonstrated by increased blood L-lactate concentrations. As a compensatory mechanism to low blood pressure and electrolyte abnormalities, aldosterone and arginine vasopressin (AVP) are released to restore organ perfusion and function. Several studies have investigated the ability of blood L-lactate concentrations to predict severity of disease and outcome in critically ill human patients, adult horses and foals. However, information on the aldosterone and AVP response to hypoperfusion and its association with L-lactate concentrations in neonatal foals is limited. OBJECTIVES To determine the association between clinical hypoperfusion and endocrine markers of reduced tissue perfusion in normo- and hypoperfused foals. STUDY DESIGN Prospective, multicentre, cross-sectional observational study. METHODS Blood samples were collected on admission from 72 clinically hypoperfused, 110 normoperfused (73 hospitalised and 37 healthy) foals of ≤4 days of age. Foals were considered clinically hypoperfused if they had L-lactate concentrations ≥2.5 mmol/l and one of the 3 following findings: heart rate >120 beats/min, packed cell volume (PCV) >0.44 l/l or azotaemia (increased creatinine and blood urea nitrogen [BUN]). Blood concentrations of aldosterone and AVP were determined by radioimmunoassays. RESULTS Aldosterone, AVP, creatinine and BUN concentrations and heart rate, PCV and blood osmolality were higher in clinically hypoperfused compared with normoperfused foals (P<0.05). Risk of hypoperfusion increased with the presence of hypothermic extremities (OR = 5.26) and with each one unit increase in albumin concentrations (OR = 3.5) (P<0.05). The proposed admission L-lactate cut-off value above which nonsurvival could be reliably predicted in hospitalised foals was 10.6 mmol/l with 82% of sensitivity and 74% of specificity. CONCLUSIONS Hyperaldosteronaemia and hypervasopressinaemia as well as hypothermic extremities and increased albumin concentrations are potent predictors of hypoperfusion in hospitalised foals.
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Affiliation(s)
- K A Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, USA
| | - S D Hurcombe
- College of Veterinary Medicine, The Ohio State University, Columbus, USA
| | - A J Stewart
- College of Veterinary Medicine, Auburn University, Alabama, USA
| | - B S Barr
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | | | - M Kinee
- Rood and Riddle Equine Hospital, Lexington, Kentucky, USA
| | - J Elam
- Hagyard Equine Medical Institute, Lexington, Kentucky, USA
| | - R E Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, USA
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Dunkel B, Corley KTT. Pathophysiology, diagnosis and treatment of neonatal sepsis. EQUINE VET EDUC 2014. [DOI: 10.1111/eve.12234] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- B. Dunkel
- Department of Clinical Science and Services; Equine Referral Hospital; The Royal Veterinary College; North Mymms UK
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