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Martín-Cuervo M, Gracia-Calvo LA, Macías-García B, Ezquerra LJ, Barrera R. Evaluation of Eosinopenia as a SIRS Biomarker in Critically Ill Horses. Animals (Basel) 2022; 12:ani12243547. [PMID: 36552467 PMCID: PMC9774166 DOI: 10.3390/ani12243547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
Systemic inflammatory response syndrome (SIRS) is a very common finding in critically ill patients. To accurately identify patients with SIRS and those who need intensive care, several markers have been evaluated, including cortisol, WBC or lactate. It is widely known that a stress leukogram includes eosinopenia as one of its main markers (neutrophilia, eosinopenia, lymphopenia and mild monocytes). It is known that cortisol concentration in plasma is the main stress biomarker and is strongly correlated with the severity of disease in horses. However, it is not possible to measure this parameter routinely in clinical conditions. Hence, in this study it was hypothesized that the eosinophil count could be a reliable parameter to identify critically ill horses. Horses included in this study were divided into three groups: Group A (sick horses received at the Emergency Unit which did not fulfil the criteria for SIRS), Group B (horses that meet two or more criteria for inclusion in the definition of SIRS) and a control group of healthy horses. In this study, horses with SIRS showed lower eosinophil counts than healthy horses. Moreover, non-surviving horses exhibited lower eosinophil counts than survivors. Eosinopenia could be used to identify horses with SIRS and can be useful as a prognostic marker.
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Affiliation(s)
- María Martín-Cuervo
- Grupo MECIAN, Departamento de Medicina Animal, Facultad de Veterinaria, Campus de Cáceres, Universidad de Extremadura, 10003 Cáceres, Spain
- Correspondence:
| | | | - Beatriz Macías-García
- Grupo MINVET, Departamento de Medicina Animal, Facultad de Veterinaria, Campus de Cáceres, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Luis Javier Ezquerra
- Grupo MECIAN, Departamento de Medicina Animal, Facultad de Veterinaria, Campus de Cáceres, Universidad de Extremadura, 10003 Cáceres, Spain
| | - Rafael Barrera
- Grupo MINVET, Departamento de Medicina Animal, Facultad de Veterinaria, Campus de Cáceres, Universidad de Extremadura, 10003 Cáceres, Spain
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Colmer SF, Luethy D, Abraham M, Stefanovski D, Hurcombe SD. Utility of cell-free DNA concentrations and illness severity scores to predict survival in critically ill neonatal foals. PLoS One 2021; 16:e0242635. [PMID: 33901192 PMCID: PMC8075268 DOI: 10.1371/journal.pone.0242635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 04/13/2021] [Indexed: 11/18/2022] Open
Abstract
Plasma cell-free DNA (cfDNA) levels have been associated with disease and survival status in septic humans and dogs. To date, studies investigating cfDNA levels in association with critical illness in foals are lacking. We hypothesized that cfDNA would be detectable in the plasma of foals, that septic and sick-nonseptic foals would have significantly higher cfDNA levels compared to healthy foals, and that increased cfDNA levels would be associated with non-survival. Animals used include 80 foals of 10 days of age or less admitted to a tertiary referral center between January and July, 2020 were stratified into three categories: healthy (n = 34), sick non-septic (n = 11) and septic (n = 35) based on specific criteria. This was a prospective clinical study. Blood was collected from critically ill foals at admission or born in hospital for cfDNA quantification and blood culture. Previously published sepsis score (SS) and neonatal SIRS score (NSIRS) were also calculated. SS, NSIRS, blood culture status and cfDNA concentrations were evaluated to predict survival. Continuous variables between groups were compared using Kruskal-Wallis ANOVA with Dunn’s post hoc test. Comparisons between two groups were assessed using the Mann-Whitney U-test or Spearman rank for correlations. The performance of cfDNA, sepsis score and NSIRS score to predict survival was assessed by receiver operator characteristic (ROC) curve analysis including area under the curve, sensitivity and specificity using cutoffs. Plasma cfDNA was detectable in all foals. No significant differences in cfDNA concentration were detected between healthy foals and septic foals (P = 0.65) or healthy foals and sick non-septic foals (P = 0.88). There was no significant association between cfDNA and culture status, SS, NSIRS or foal survival. SS (AUC 0.85) and NSIRS (AUC 0.83) were superior to cfDNA (AUC 0.64) in predicting survival. Although cfDNA was detectable in foal plasma, it offers negligible utility to diagnose sepsis or predict survival in critical illness in neonates.
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Affiliation(s)
- Sarah Florence Colmer
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Daniela Luethy
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Michelle Abraham
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Darko Stefanovski
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
| | - Samuel David Hurcombe
- Department of Clinical Sciences, The University of Pennsylvania School of Veterinary Medicine, New Bolton Center, Philadelphia, Pennsylvania, United States of America
- * E-mail:
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Weaver LF, Boileau MJ, Gilliam LL, Taylor JD. Characterization of short- and long-term morbidity and mortality of goat kids born to does with pregnancy toxemia. J Vet Intern Med 2021; 35:1155-1163. [PMID: 33634496 PMCID: PMC7995436 DOI: 10.1111/jvim.16069] [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: 08/24/2020] [Revised: 01/28/2021] [Accepted: 02/04/2021] [Indexed: 12/03/2022] Open
Abstract
Background Pregnancy toxemia is a common metabolic disease of periparturient small ruminants. Information on its effects on metabolism and perinatal adaptation of newborn lambs and kids is lacking. Objectives Evaluate differences in morbidity, mortality, and common biochemical and hematologic variables between pregnancy toxemia kids (PT) and control kids (CON). Animals Sixteen kids born to does being treated at the hospital for pregnancy toxemia (blood beta‐hydroxybutyrate concentration [BHB] > 1.2 mmol/L) and 12 kids from healthy dams (dam BHB < 1.2 mmol/L) that kidded at the hospital. Methods In this cohort study, serial measurements of blood l‐lactate, glucose, and BHB concentrations, arterial blood gases, hematocrit, total protein concentrations, nonesterified fatty acids (NEFAs) concentrations, and body weight were compared between groups over the first 72 hours of life. Long‐term follow‐up was performed after 3 months. Results Pregnancy toxemia kids were more likely to require tube feeding at 0 and 12 hours (relative risk 7.7 [1.13, 52.45] and 2.8 [1.39, 5.65]). Pregnancy toxemia kids were more acidemic (7.26 ± 0.069 vs 7.34 ± 0.079, P = .003) and hyperlactatemic (8.17 ± 2.57 vs 5.48 ± 2.71, P = .003) at birth than CON kids. Control kids were 1.1 [1.01, 1.77] times more likely to survive to discharge and 2.2 [1.15, 4.20] times more likely to survive to 3 months than PT kids. Conclusions and Clinical Importance Pregnancy toxemia kids had higher short‐ and long‐term mortality and were more likely to require perinatal intervention. Weight loss in the first few days could be a useful predictor of nonsurvival.
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Affiliation(s)
- Leslie F Weaver
- Veterinary Clinical Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Melanie J Boileau
- Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Lyndi L Gilliam
- Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma, USA
| | - Jared D Taylor
- Veterinary Pathobiology, Oklahoma State University, Stillwater, Oklahoma, USA
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Boakari YL, Alonso MA, Riccio AV, Affonso FJ, Losano JDDA, Nichi M, Belli CB, Fernandes CB. Evaluation of Blood Glucose and Lactate Concentrations in Mule and Equine Foals. J Equine Vet Sci 2021; 101:103369. [PMID: 33993946 DOI: 10.1016/j.jevs.2020.103369] [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: 10/14/2020] [Revised: 12/24/2020] [Accepted: 12/24/2020] [Indexed: 11/24/2022]
Abstract
Information about mule physiology is scarce. Glucose and lactate serve as prognostic tools in neonates; thus, real-time evaluations would be beneficial. Our main objective was to measure glucose and lactate concentrations from healthy mule and equine foals from birth to 720 hours. Glucose and lactate concentrations were evaluated with a benchtop Randox Daytona analyzer (LAB) using plasma and with an Accutrend Plus system (ACP) using whole blood. Data were analyzed using PROC MIXED (P < .05), intraclass coefficient correlation and Bland-Altman analysis. Glucose and lactate concentrations from mule and equine foals were different when evaluated with LAB, but there was no difference when evaluated with ACP. Glucose pattern of variation, evaluated with both analyzers for mule and equine foals, had an increase, with subsequent decrease, whereas lactate pattern of variation had initial higher values with subsequent decrease. Intraclass coefficient correlation for glucose was low and moderate for lactate. Results of glucose and lactate with ACP from our experimental neonates were not highly correlated with LAB. However, the ACP had the same pattern of variation for glucose and lactate, thus can still be used clinically for immediate evaluations if the technique is standardized with the specific samples that will be used.
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Affiliation(s)
- Yatta Linhares Boakari
- Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn, AL
| | - Maria Augusta Alonso
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil
| | - Amanda Vallone Riccio
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil
| | - Fernanda Jordão Affonso
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil
| | - João Diego de Agostini Losano
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil
| | - Marcilio Nichi
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil
| | - Carla Bargi Belli
- Internal Medicine Department, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil
| | - Claudia Barbosa Fernandes
- Department of Animal Reproduction, School of Veterinary Medicine and Animal Science, University of Sao Paulo, São Paulo, Brazil.
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Stefanovski D, Wilkins PA, Boston RC. Modeling Challenge Data to Quantify Endogenous Lactate Production. Front Endocrinol (Lausanne) 2021; 12:656054. [PMID: 34267726 PMCID: PMC8277460 DOI: 10.3389/fendo.2021.656054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 06/07/2021] [Indexed: 11/13/2022] Open
Abstract
With the intention of isolating the susceptibility of modeling methodology to influence our investigation of the infusion data, we used three kinetic approaches to our models: a simple approach, a unit approach, and a novel approach. The simple approach used exclusively built-in modeling features of the software in terms of units of the infusion dilution (mmol/L), as well as in terms of the precision of switching the infusion on and off. The unit approach used the same switching mechanism as the simple approach, but the units were modeled in those of the infusion (e.g., mmol/kg). Thirdly with the novel approach, we used an automated approach to controlling the infusion, in the sense that as the modeling mechanism sensed the slowdown of the infusion, it was gradually turned off. The units of the analysis for the novel approach were exactly the same as those deployed in the unit approach. Our objective here was to see if common pharmacokinetic parameters were seriously impacted by the particular modeling method.
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Affiliation(s)
- Darko Stefanovski
- Department of Clinical Studies – New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
- *Correspondence: Darko Stefanovski,
| | - Pamela A. Wilkins
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana-Champaign, IL, United States
| | - Raymond C. Boston
- Department of Clinical Studies- New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, United States
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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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Blood L-Lactate Concentration as an Indicator of Outcome in Roe Deer ( Capreolus capreolus) Admitted to a Wildlife Rescue Center. Animals (Basel) 2020; 10:ani10061066. [PMID: 32575686 PMCID: PMC7341283 DOI: 10.3390/ani10061066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/15/2020] [Accepted: 06/17/2020] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Roe deer are among the most frequent wild animals admitted to rescue centers in Italy. Reasons for admission include trauma, predation, starvation, and imprinting, with the final aim of hospitalization being full recovery and release into the wild for all cases. An accurate triage procedure is vital for predicting the outcome, to avoid unnecessary time spent in captivity, and an excessive allocation of time and resources on animals with a minimal chance of recovery. Since lactacidosis is often associated with death in hospitalized animals, and has been associated with poor prognosis in humans and domestic animals, we proposed an evaluation of blood L-lactate using a rapid whole blood test in order to predict the outcome of hospitalized roe deer. A cut-off of 10.2 mmol/L was identified as the best, in order distinguish animals with minimal chance of surviving and release. For these animals, humane euthanasia should be considered as an option. Abstract Roe deer (Capreolus capreolus) are among the most frequent patients of rescue centers in Italy. Three outcomes are possible: natural death, euthanasia, or treatment and release. The aim of the present study is to propose blood L-lactate concentration as a possible prognostic biomarker that may assist veterinarians in the decision-making process. Sixty-three roe deer, admitted to one rescue center in the period between July 2018 and July 2019, were sampled and divided into 4 groups according to their outcome: (1) spontaneous death (17 cases), (2) humanely euthanized (13 cases), (3) fully recovered and released (13 cases), and (4) euthanized being unsuitable for release (20 cases). In addition, blood samples from 14 hunted roe deer were analyzed as controls. Whole blood lactate concentrations were measured with a point of care lactate meter. Differences among groups were close to statistical significance (p = 0.51). A cut-off value of 10.2 mmol/L was identified: all the animals with higher values died or were humanely euthanized. The results suggest that roe deer with lactatemia higher than 10.2 mmol/L at admission, have a reduced prognosis for survival during the rehabilitation period, regardless of the reason for hospitalization and the injuries reported. Therefore, humane euthanasia should be considered for these animals.
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8
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Martín-Cuervo M, Aguirre CN, Gracia LA, Barrera R, Ezquerra LJ, Martinez-Subiela S, Cerón JJ. Usefulness of a Point-of-Care Analyzer to Measure Cardiac Troponin I and D-Dimer Concentrations in Critically Ill Horses With Gastrointestinal Diseases. J Equine Vet Sci 2020; 90:102965. [PMID: 32534789 DOI: 10.1016/j.jevs.2020.102965] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/10/2020] [Accepted: 02/10/2020] [Indexed: 11/19/2022]
Abstract
Point-of-care (POC) systems for the joint measurement of Troponin and D-dimers have not been studied in horses. The aim of this study was to perform the validation of a POC system (AQT90 FLEX) for the measurement of cardiac troponin I (cTnI) and D-dimers in the serum of horses with gastrointestinal diseases. The main objective was to evaluate whether or not this system can distinguish healthy animals from diseased animals. A sample of 33 horses was included in the study: control group (n = 10) and horses with gastrointestinal disorders (n = 21), which were classified according to their outcome in survivors (subgroup A = 9) and nonsurvivors (subgroup B = 12). Considering the diagnosis of the process, ill horses were classified into three groups: inflammatory (I = 7), obstructive (O = 9), and strangulating diseases (S = 5). The clinical usefulness of AQT90 FLEX was validated by the study of linearity, coefficient of variation, and detection limits. Later, concentrations of D-dimers and cTnI were measured. A significant increase in both parameters was detected in ill animals (cTnI: control: 0.014 ± 0.01 μg/mL, survivors: 0.27 ± 0.37 μg/mL, nonsurvivors: 0.60 ± 1.21 μg/mL; D-dimers: control: 104.90 ± 30.82 ng/mL, survivors: 1,217.22 ± 1,213.28 ng/mL, nonsurvivors: 1,613.67 ± 1,426.75 ng/mL), although there were no statistically significant differences in concentrations according to diagnosis and outcome. In conclusion, AQT90 FLEX POC analyzer can be used in horses with gastrointestinal diseases to measure cTnI and D-dimer concentrations. It is a quick, practical, and minimally invasive tool that helps in determining the severity of illness.
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Affiliation(s)
- María Martín-Cuervo
- Animal Medicine Department, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain.
| | - Carla N Aguirre
- Veterinary Teaching Hospital, University of Murcia, Murcia, Spain
| | - Luis Alfonso Gracia
- Animal Medicine Department, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - Rafael Barrera
- Animal Medicine Department, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - Luis Javier Ezquerra
- Animal Medicine Department, Veterinary Teaching Hospital, University of Extremadura, Cáceres, Spain
| | - Silvia Martinez-Subiela
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
| | - José Joaquín Cerón
- Department of Animal Pathology, Faculty of Veterinary Medicine, University of Murcia, Murcia, Spain
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Rosenstein PG, Tennent-Brown BS, Hughes D. Clinical use of plasma lactate concentration. Part 2: Prognostic and diagnostic utility and the clinical management of hyperlactatemia. J Vet Emerg Crit Care (San Antonio) 2018. [PMID: 29533517 DOI: 10.1111/vec.12706] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To review the current literature pertaining to the use of lactate as a prognostic indicator and therapeutic guide, the utility of measuring lactate concentrations in body fluids other than blood or plasma, and the clinical management of hyperlactatemia in dogs, cats, and horses. DATA SOURCES Articles were retrieved without date restrictions primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS Increased plasma lactate concentrations are associated with increased morbidity and mortality. In populations with high mortality, hyperlactatemia is moderately predictive in identifying nonsurvivors. Importantly, eulactatemia predicts survival better than hyperlactatemia predicts death. Consecutive lactate measurements and calculated relative measures appear to outperform single measurements. The use of lactate as a therapeutic guide has shown promising results in people but is relatively uninvestigated in veterinary species. Increased lactate concentrations in body fluids other than blood should raise the index of suspicion for septic or malignant processes. Management of hyperlactatemia should target the underlying cause. CONCLUSION Lactate is a valuable triage and risk stratification tool that can be used to separate patients into higher and lower risk categories. The utility of lactate concentration as a therapeutic target and the measurement of lactate in body fluids shows promise but requires further research.
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Affiliation(s)
- Patricia G Rosenstein
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Brett S Tennent-Brown
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
| | - Dez Hughes
- Department of Veterinary Clinical Sciences, Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Werribee, Victoria, Australia
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10
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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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12
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Cole GC, Tordiffe ASW, Steenkamp G. Assessment of a portable lactate meter for field use in the white rhinoceros (<i>Ceratotherium simum</i>). ACTA ACUST UNITED AC 2017; 84:e1-e10. [PMID: 29227129 PMCID: PMC8552300 DOI: 10.4102/ojvr.v84i1.1399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 07/23/2017] [Accepted: 07/25/2017] [Indexed: 11/13/2022]
Abstract
Blood lactate is a predictor of mortality in critically ill humans and animals. Handheld lactate meters have the potential to be used in the field to evaluate the condition of severely injured rhinoceroses but have not been compared with laboratory-based methods. Agreement between a handheld lactate meter and a laboratory method was assessed, as was the stability of rhino blood lactate in the anticoagulant sodium fluoride/potassium oxalate (fluoride/oxalate). Blood samples were obtained from 53 white rhinos that had been immobilised for management reasons. Lactate was measured by means of a handheld meter using whole blood in heparin (WBHEP), whole blood in fluoride/oxalate (WBFO) and fluoride/oxalate plasma (PFO). Results were recorded in both blood (BL) and plasma (PL) modes and compared to an established laboratory method for measuring plasma lactate. To assess the stability of lactate over time, blood lactate in fluoride/oxalate was measured on the handheld meter at intervals for up to 91 h. Agreement was best using WBFO in PL mode, with small bias (−0.16), tight 95% limits of agreement (LOA) (−1.46, 1.14) and a Pc (95% CI) of 0.97 (0.92, 0.99). The agreement was improved for all sample types when using the PL mode compared to the blood lactate (BL) mode. Blood lactate was stable in fluoride/oxalate for 91 h, with a mean change from baseline of 0.15 (−0.178, 0.478) mmol/L (mean, 95% CI). The handheld meter was found to be suitable for field use in white rhinos but provided more reliable results with the device in PL mode. Furthermore, rhino blood lactate was found to be stable in fluoride/oxalate for as long as 3 days.
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Affiliation(s)
- Georgina C Cole
- Department of Companion Animal Clinical Studies, University of Pretoria.
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Castagnetti C, Cunto M, Bini C, Mariella J, Capolongo S, Zambelli D. Time-dependent changes and prognostic value of lactatemia during the first 24 h of life in brachycephalic newborn dogs. Theriogenology 2017; 94:100-104. [PMID: 28407851 DOI: 10.1016/j.theriogenology.2017.01.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/23/2017] [Accepted: 01/30/2017] [Indexed: 11/17/2022]
Abstract
Blood lactate concentration is known to be a good prognostic indicator associated with the severity of illness and the patient's outcome both in human and veterinary medicine. It also plays a significant role in the assessment of the newborn, being a good indicator of fetal hypoxia and the ideal predictor of morbidity at term in babies. In veterinary neonatal medicine, hyperlactatemia is considered a valid prognostic marker in critically ill foals; moreover, blood lactate measurement has been proposed for the evaluation of newborn viability and the assessment of fetal distress during delivery in dogs. Unfortunately, only a few studies have been published concerning the canine species. The present work examines 67 brachycephalic newborn dogs and their mothers, with the aim to evaluate the time-dependent changes of blood lactate and glucose concentration during the first 24 h after vaginal or caesarean delivery both in puppies and bitches. To our knowledge, this is the first published study examining the time-dependent changes of these parameters in the bitch after parturition. Within the studied population of puppies, non-surviving was significantly associated with a higher lactatemia and a lower APGAR score. Blood lactate was high at birth then progressively decreased during the first 24 h of life and a lack of normalization of blood lactate levels within this time interval was suggestive for a poor prognosis for the newborn dogs; moreover, the decrease appeared to be slower after vaginal delivery. Lactatemia also showed a positive correlation with glycemia at birth. Concerning the bitches examined, blood lactate was found to be significantly higher after vaginal delivery than after caesarean section; the normalization occurred within 24 h after parturition. Blood glucose level was significantly higher at 2 h from delivery both in the group of bitches submitted to caesarean section and in those undergoing natural whelping but no statistical correlation was found between maternal glycemia and lactatemia. The results of the present study highlighted that the monitoring of lactatemia during the first 24 h of life, in association with the assessment of the APGAR score at birth, can be an useful prognostic tool helping to identify the most severely distressed puppies and to provide them an adequate support.
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Affiliation(s)
- C Castagnetti
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - M Cunto
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - C Bini
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, Bologna, Italy
| | - J Mariella
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, Bologna, Italy.
| | - S Capolongo
- Ambulatorio Veterinario, Via Campo di Pozzo 289, San Felice sul Panaro, 41038, Modena, Italy
| | - D Zambelli
- Department of Veterinary Medical Sciences, University of Bologna, Via Tolara di Sopra 50, 40064, Ozzano dell'Emilia, Bologna, Italy
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Efficacy and Safety of a Commercial Fresh-Frozen Hyperimmune Plasma in Foals With Failure of Passive Transfer of Immunity. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2016.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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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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16
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17
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Hypoglycaemia in hospitalised neonatal calves: Prevalence, associated conditions and impact on prognosis. Vet J 2016; 217:103-108. [PMID: 27810199 DOI: 10.1016/j.tvjl.2016.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 09/27/2016] [Accepted: 10/01/2016] [Indexed: 11/21/2022]
Abstract
Hypoglycaemia has traditionally been associated with neonatal diarrhoea and endotoxaemia in calves, but the clinical relevance of this finding in spontaneously diseased calves has not previously been evaluated. To determine the prevalence and prognostic relevance of severe hypoglycaemia (plasma glucose concentration < 2 mmol/L), data from 10,060 hospitalised calves (≤21 days of age) were retrospectively analysed. Additionally, clinical findings and diagnoses in a subset of 100 calves with severe hypoglycaemia were compared with those in 100 randomly selected calves with initial plasma glucose concentrations in the reference range (4.4-6.9 mmol/L). The prevalence of severe hypoglycaemia in the whole study sample was 6.3%. Severe hypoglycaemia was associated with a poor survival rate of 20.6% vs. 74.0% discharged animals in the group of calves with initial normoglycaemia. Review of medical records revealed that severe hypoglycaemia was significantly associated with clinical or necropsy evidence of septicaemia, hypothermia, history or clinical evidence of malnutrition, and peritonitis of varied origin, but not with the presence of neonatal diarrhoea. Only 10 of 100 calves with severe hypoglycaemia showed central nervous involvement such as seizures and opisthotonus. In conclusion, severe hypoglycaemia has a low prevalence in diseased calves in a hospital setting, but is associated with serious health problems and therefore a high risk of non-survival. Severe hypoglycaemia was not easily diagnosed based on clinical signs, but should be suspected in calves with clinical evidence of septicaemia, hypothermia, acute abdominal emergencies, and a history or clinical evidence of malnutrition.
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18
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Prognostic Indicators for Survival and Athletic Outcome in Critically Ill Neonatal Foals. Vet Clin North Am Equine Pract 2016; 31:615-28. [PMID: 26612751 DOI: 10.1016/j.cveq.2015.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Equine neonatal intensive care units have expanded knowledge and understanding of the normal and abnormal physiology of the equine neonate, resulting in successful treatment of critically ill equine neonates. The overall survival rate has increased tremendously since the early 1980s, from a little more than 50% to 80% or more for most facilities. The severely septic foal and the very premature foal still remain large treatment challenges, but less severely septic foals and foals challenged by adverse peripartum events such as dystocia and placentitis are surviving to hospital discharge and performing to the owners' expectation in larger numbers.
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19
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Rodríguez-Balderrama I, Ostia-Garza P, Villarreal-Parra R, Tijerina-Guajardo M. Risk factors and the relation of lactic acid to neonatal mortality in the first week of life. MEDICINA UNIVERSITARIA 2016. [DOI: 10.1016/j.rmu.2015.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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20
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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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21
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Viu J, Armengou L, Ríos J, Cesarini C, Jose-Cunilleras E. Acid base imbalances in ill neonatal foals and their association with survival. Equine Vet J 2015; 49:51-57. [DOI: 10.1111/evj.12542] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/17/2015] [Indexed: 11/29/2022]
Affiliation(s)
- J. Viu
- Servei de Medicina Interna Equina; Unitat Equina Fundació Hospital Clínic Veterinari i Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
| | - L. Armengou
- Servei de Medicina Interna Equina; Unitat Equina Fundació Hospital Clínic Veterinari i Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
| | - J. Ríos
- Laboratory of Biostatistics and Epidemiology; IDIBAPS; Hospital Clínic; Universitat Autònoma de Barcelona and Statistics and Methodology Support Unit; Barcelona Spain
| | - C. Cesarini
- Servei de Medicina Interna Equina; Unitat Equina Fundació Hospital Clínic Veterinari i Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
| | - E. Jose-Cunilleras
- Servei de Medicina Interna Equina; Unitat Equina Fundació Hospital Clínic Veterinari i Departament de Medicina i Cirurgia Animals; Facultat de Veterinària; Universitat Autònoma de Barcelona; Barcelona Spain
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22
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Affiliation(s)
- J. R. Gold
- Department of Clinical Sciences; Washington State University; Pullman USA
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23
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Defining the Systemic Inflammatory Response Syndrome in Equine Neonates. Vet Clin North Am Equine Pract 2015; 31:463-81. [DOI: 10.1016/j.cveq.2015.08.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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24
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Sheahan BJ, Wilkins PA, Lascola KM, Martin V, Po E. The area under the curve of L-lactate in neonatal foals from birth to 14 days of age. J Vet Emerg Crit Care (San Antonio) 2015; 26:305-9. [PMID: 26595884 DOI: 10.1111/vec.12419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/12/2015] [Accepted: 04/11/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Prior studies have shown the prognostic utility of measuring L-lactate in critically ill neonatal foals, both as single (at admission) and serial measurements. Greater prognostic sensitivity and specificity may be achieved by use of the area under the L-lactate versus time curve (LACArea ) over the first 24 hours of hospitalization, which captures both severity and duration of hyperlactatemia. Prior to application of this concept in sick equine neonates, a reference interval for LACArea should be determined. METHODS The concentration of lactate [LAC] was measured in blood obtained via direct jugular venipuncture from clinically normal foals on Days 1 (birth-24 h of age), 3, 7, and 14 following birth at 6-hour intervals for each 24-hour period. LACArea was calculated using the trapezoidal method. Differences in LACArea by Day were determined by MANOVA with a priori Bonferroni correction, P ≤ 0.05. RESULTS LACArea differed by Day (P = 0.001), being largest on Day 1, followed by Day 3. Days 7 and 14 were smallest and not different from each other. CONCLUSION LACArea decreases substantially and predictably over the first week of life in normal neonatal foals. Knowing how LACArea normally changes over the first 2 weeks of life will aid in future study of LACArea as it applies to sick neonatal foals, allowing for consideration of maturational changes potentially unrelated to disease.
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Affiliation(s)
- Breanna J Sheahan
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Pamela A Wilkins
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Kara M Lascola
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Victoria Martin
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL, 61802
| | - Eleonora Po
- Department of Veterinary Clinical Medicine, University of Illinois College of Veterinary Medicine, 1008 West Hazelwood Drive, Urbana, IL, 61802
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25
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Gomez D, Biermann N, Sanchez L. Physicochemical Approach to Determine the Mechanism for Acid-Base Disorders in 793 Hospitalized Foals. J Vet Intern Med 2015; 29:1395-402. [PMID: 26256847 PMCID: PMC4858039 DOI: 10.1111/jvim.13590] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 05/12/2015] [Accepted: 07/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The quantitative effect of strong electrolytes, unmeasured strong anions (UAs), pCO2, and plasma protein concentrations in determining plasma pH can be demonstrated using the physicochemical approach. Plasma anion gap (AG) and strong ion gap (SIG) are used to assess UAs in different species. HYPOTHESES Strong ions are a major factor influencing changes in plasma pH of hospitalized foals. AG and SIG accurately predict severe hyper-L-lactatemia ([L-lac(-)] > 7 mmol/L). ANIMALS Seven hundred and ninety three hospitalized foals < 7 days old. METHODS Retrospective study. The relationship between measured pH and physicochemical variables, and the relationship between plasma [L-lac(-)] and AG and SIG, were determined using regression analyses. Optimal AG and SIG cut points to predict hyper-L-lactatemia were identified using an ROC curve analysis. RESULTS Combined, the measured strong ion difference and SIG accounted for 54-69% of the changes in the measured arterial pH of hospitalized foals. AG and SIG were significantly associated with plasma [L-lac(-)] (P < .0001). The receiver operator characteristics (ROC) AUC of AG and SIG for prediction of severe hyper-L-lactatemia were 0.89 (95%CI, 0.8-0.95; P < .0001) and 0.90 (95%CI, 0.81-0.96; P < .0001), respectively. Severe hyper-L-lactatemia was best predicted by AG > 27 mmol/L (sensitivity 80%, 95%CI, 56-94, specificity 85%, 95%CI, 73-93; P < .0001) and SIG <-15 mmol/L (sensitivity 90%, 95%CI, 68-98; specificity 80%; 95%CI, 68-90; P < .0001). CONCLUSION AND CLINICAL RELEVANCE Altered concentrations of strong ions (Na(+), K(+), Cl(-)) and UAs were the primary cause of acidemia of hospitalized foals. AG and SIG were good predictors of hyper-L-lactatemia and could be used as surrogate tests.
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Affiliation(s)
- D.E. Gomez
- Department of Health ManagementAtlantic Veterinary CollegeUniversity of Prince Edward IslandCharlottetownPECanada
| | - N.M. Biermann
- Department of Health ManagementAtlantic Veterinary CollegeUniversity of Prince Edward IslandCharlottetownPECanada
| | - L.C. Sanchez
- Department of Large Animal Clinical SciencesCollege of Veterinary MedicineUniversity of FloridaGainesvilleFLUSA
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26
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Hytychová T, Bezděková B. Retrospective evaluation of blood culture isolates and sepsis survival rate in foals in the Czech Republic: 50 cases (2011-2013). J Vet Emerg Crit Care (San Antonio) 2015. [PMID: 26220509 DOI: 10.1111/vec.12348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To identify the specific pathogens causing sepsis in hospitalized foals in the Czech Republic and identify important factors associated with their survival. DESIGN A retrospective study from 2011 to 2013. SETTING University veterinary teaching hospital. ANIMALS Fifty compromised foals. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Blood was aseptically collected for bacterial culture from compromised foals. The foals were classified as septic according to a positive blood culture result or sepsis score ≥11. Blood cultures were positive in 44% of the foals. In these positive cultures, 27.3% had only Gram-positive (G+) bacteria and 54.5% had only Gram-negative (G-) bacteria. A mixed bacterial population was presented in 18.2% of the positive cultures. Thirty-six foals were classified as septic on the basis of positive blood culture or a sepsis score ≥11. In the group of foals that did not survive, there were significantly more foals with low levels of immunoglobulin G (IgG) than foals with normal levels of IgG (P < 0.0001). We also found a significant difference in the proportion of foals with low levels of IgG and positive blood cultures when compared to negative blood cultures. Twenty-six of the 50 foals were discharged from the hospital. Survival was significantly lower in foals with a diagnosis of sepsis than in foals without sepsis. There was no statistically significant difference between foals that died as a result of infection caused by G- or G+ pathogens. There was no difference in the proportion of survivors that did or did not receive antimicrobials prior to admission. CONCLUSIONS In our study, we confirmed the increasing trend for G+ bacteria in blood cultures but G- still predominate. The percentage of nonsurviving septic foals was high.
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Affiliation(s)
- Tat'ana Hytychová
- Equine Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | - Barbora Bezděková
- Equine Clinic, Faculty of Veterinary Medicine, University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
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27
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Hollis AR, Wilkins PA, Tennent-Brown B, Palmer JE, Boston RC. The effect of intravenous fresh frozen plasma administration on fibrinogen and albumin concentrations in sick neonatal foals. EQUINE VET EDUC 2015. [DOI: 10.1111/eve.12386] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- A. R. Hollis
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania School of Veterinary Medicine; Kennett Square USA
| | - P. A. Wilkins
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania School of Veterinary Medicine; Kennett Square USA
| | - B. Tennent-Brown
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania School of Veterinary Medicine; Kennett Square USA
| | - J. E. Palmer
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania School of Veterinary Medicine; Kennett Square USA
| | - R. C. Boston
- Department of Clinical Studies; New Bolton Center; University of Pennsylvania School of Veterinary Medicine; Kennett Square USA
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28
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Wilkins P, Sheahan B, Vander Werf K, Castagnetti C, Hardy J, Schoster A, Boston R. Preliminary investigation of the area under the L-lactate concentration-time curve (LACArea) in critically ill equine neonates. J Vet Intern Med 2015; 29:659-62. [PMID: 25818220 PMCID: PMC4895514 DOI: 10.1111/jvim.12559] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 12/13/2014] [Accepted: 01/20/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND A variety of measures of L-lactate concentration ([LAC]) in the blood of critically ill neonatal foals have shown utility as prognostic indicators. These measures, evaluating either the severity of hyperlactatemia or the duration of exposure to hyperlactatemia, perform fairly well and have correctly classified 75-80% of foals examined in several studies. The area under the L-lactate concentration versus time curve (LACArea) encompasses both severity and duration of hyperlactatemia and should improve correct classification of patient survival. HYPOTHESIS/OBJECTIVES LACArea is larger in nonsurviving critically ill neonatal foals. ANIMALS Forty-nine foals admitted for critical illness to 1 of 4 referral hospitals. METHODS Whole blood was obtained at admission and 6, 12, 18, and 24 hours after admission for measurement of L-lactate using a handheld lactate meter. LACArea was calculated for: admission-6, 6-12, 12-18, 18-24 hours, and admission-24 hours using the trapezoidal method and summing the 6-hours interval areas to determine total 24 hours area. Differences between survivors and nonsurvivors were determined using robust regression and Kruskal-Wallis testing, P < .05. RESULTS LACArea was significantly larger in nonsurviving foals (n = 9) than in surviving foals (n = 40) at all time periods examined. CONCLUSIONS AND CLINICAL IMPORTANCE Differences in LACArea between surviving and nonsurviving critically ill neonatal foals are large and support further investigation of this method as an improved biomarker for survival in critically ill neonatal foals is indicated.
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Affiliation(s)
- P.A. Wilkins
- Department of Veterinary Clinical MedicineCollege of Veterinary MedicineUniversity of IllinoisUrbanaIL
| | - B.J. Sheahan
- Department of Veterinary Clinical MedicineCollege of Veterinary MedicineUniversity of IllinoisUrbanaIL
| | - K.A. Vander Werf
- Department of Veterinary Clinical MedicineCollege of Veterinary MedicineUniversity of IllinoisUrbanaIL
| | - C. Castagnetti
- Department of Veterinary Medical SciencesUniversity of BolognaBolognaItaly
| | - J. Hardy
- Department of Large Animal Clinical SciencesCollege of Veterinary Medicine & Biomedical SciencesTexas A & M UniversityCollege StationTX
| | - A. Schoster
- Vetsuisse FacultyUniversity of ZurichZurichSwitzerland
| | - R.C. Boston
- Department of Clinical StudiesNew Bolton CenterUniversity of Pennsylvania School of Veterinary MedicineKennett SquarePA
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29
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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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30
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Radcliffe RM, Buchanan BR, Cook VL, Divers TJ. The clinical value of whole blood point-of-care biomarkers in large animal emergency and critical care medicine. J Vet Emerg Crit Care (San Antonio) 2015; 25:138-51. [PMID: 25590562 DOI: 10.1111/vec.12276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 09/15/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To summarize the current medical literature and provide a clinical perspective of whole blood point-of-care (POC) biomarkers in large animal emergency and critical care practice. DATA SOURCES Original studies, reviews, and textbook chapters in the human and veterinary medical fields. SUMMARY POC biomarkers are tests used to monitor normal or disease processes at or near the patient. In both human and veterinary medicine these tools are playing an increasingly important role in the management of critical diseases. The most important whole blood POC biomarkers available for veterinary practitioners include l-lactate, cardiac troponin I, serum amyloid A, triglyceride, creatinine, and glucose, although many other tests are available or on the horizon. CONCLUSION Whole blood POC biomarkers enable clinicians to provide improved management of critical diseases in large animals. These tools are especially useful for establishing a diagnosis, guiding therapy, and estimating disease risk and prognosis.
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Affiliation(s)
- Rolfe M Radcliffe
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Abstract
Sepsis is defined as an exaggerated, systemic inflammatory response to infection and is a common condition in horses. Systemic inflammatory response syndrome (SIRS) associated with bacterial infection is a hallmark of sepsis. Sepsis in neonatal foals is a common sequela of failure of passive transfer and, in addition to development of SIRS, may be characterised by bacteraemia, pneumonia, enterocolitis, omphalophlebitis, meningoencephalitis or arthritis. Sepsis in mature horses is most commonly observed secondary to gastrointestinal lesions that result in disrupted mucosa and bacterial translocation into circulation (endotoxaemia). Pleuropneumonia and metritis may also cause sepsis in mature horses. Diagnosis of sepsis is based on SIRS criteria as well as suspected or confirmed infection. Due to the relatively low sensitivity of microbial culture and the subjectivity of sepsis scoring, many sepsis biomarkers are being studied for their usefulness in diagnosis and prognostication of sepsis in horses. Treatment of sepsis requires an intensive care approach that includes antimicrobial drug administration, fluid resuscitation and pressure support, and treatment for inflammation, endotoxaemia and coagulopathy. Early recognition of sepsis and prompt antimicrobial drug treatment are critical for a successful outcome. Multiple organ dysfunction syndrome may occur in severe cases of sepsis, with common manifestations including laminitis and coagulopathies. Although prognosis for septic mature horses depends highly on the primary disease process, the overall survival rate in septic neonatal foals ranges from 26 to 86%, with most studies indicating a survival rate of 45-60%.
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Affiliation(s)
- S Taylor
- Veterinary Clinical Sciences Purdue University West Lafayette Indiana USA
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32
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Tennent-Brown B. Blood lactate measurement and interpretation in critically ill equine adults and neonates. Vet Clin North Am Equine Pract 2014; 30:399-413, viii. [PMID: 25016498 DOI: 10.1016/j.cveq.2014.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Admission blood lactate concentration is widely used as a prognostic indicator in equine medicine and can be a useful indicator of disease severity but typically fails to completely discriminate survivors from nonsurvivors. Increased admission lactate concentrations in adult horses typically return to normal within 12 to 24 hours. Lactate concentrations in neonatal foals are higher than adult concentrations for the first 24 to 72 hours of life. Serial measures reflecting both the magnitude and duration of hyperlactatemia might enable more accurate prognostication and provide insight into disease pathogenesis and could be a valuable therapeutic guide.
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Affiliation(s)
- Brett Tennent-Brown
- Faculty of Veterinary Science, Equine Centre, The University of Melbourne, 250 Princess Highway, Werribee, Victoria 3030, Australia.
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Borchers A, Wilkins PA, Marsh PM, Axon JE, Read J, Castagnetti C, Pantaleon L, Clark C, Qura'n L, Belgrave R, Schwarzwald C, Levy M, Bedenice D, Saulez MN, Boston RC. Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study. Equine Vet J 2013:2-7. [DOI: 10.1111/evj.12165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 06/25/2013] [Indexed: 02/04/2023]
Affiliation(s)
- A. Borchers
- University of Pennsylvania; USA
- University of California; USA
| | - P. A. Wilkins
- University of Pennsylvania; USA
- University of Illinois; USA
| | | | | | - J. Read
- Equine Medical Center of Ocala; USA
| | | | | | - C. Clark
- Peterson Smith Equine Hospital; USA
| | | | | | | | - M. Levy
- Purdue University; Indiana USA
| | - D. Bedenice
- Tufts Cummings School of Veterinary Medicine; USA
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Borchers A, Magdesian KG, Schenck PA, Kass PH. Serial plasma vasopressin concentration in healthy and hospitalised neonatal foals. Equine Vet J 2013; 46:306-10. [DOI: 10.1111/evj.12121] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Accepted: 06/09/2013] [Indexed: 01/05/2023]
Affiliation(s)
- A. Borchers
- William R. Pritchard Veterinary Medical Teaching Hospital; University of California; USA
| | - K. G. Magdesian
- Department of Medicine and Epidemiology; University of California; USA
| | - P. A. Schenck
- Diagnostic Center for Population and Animal Health; Michigan State University; USA
| | - P. H. Kass
- Department of Population Health and Reproduction; University of California; USA
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35
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Bertone J. Ethical, scientific and practical standards in clinical practice research. Equine Vet J 2013; 45:391-3. [DOI: 10.1111/evj.12062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- J. Bertone
- College of Veterinary Medicine; Western University of Health Sciences; California; USA
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36
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Henderson ISF. Diagnostic and prognostic use of L-lactate measurement in equine practice. EQUINE VET EDUC 2013. [DOI: 10.1111/eve.12033] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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