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Laurberg M, Saegerman C, Jacobsen S, Berg LC, Laursen SH, Hoeberg E, Sånge EA, van Galen G. Use of admission serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations as a marker of sepsis and outcome in neonatal foals. PLoS One 2023; 18:e0285819. [PMID: 37200285 DOI: 10.1371/journal.pone.0285819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 05/02/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Equine neonatal sepsis can be challenging to diagnose and prognosticate. Neutrophil gelatinase-associated lipocalin (NGAL), a new marker of renal damage and inflammation, can potentially be helpful. OBJECTIVES To evaluate NGAL in neonatal foals with sepsis, and assess its relation to outcome. ANIMALS Foals ≤ 14 days, with admission blood analysis and stored serum. METHODS NGAL was measured on stored serum from 91 foals. Foals were scored for sepsis and survival and categorized according to sepsis status (septic, sick non-septic, healthy, and uncertain sepsis status) and outcome groups (survivors and non-survivors). The septic foals were further sub-categorized according to severity (normal sepsis, severe sepsis and septic shock). A Kruskal-Wallis test was used to compare serum NGAL concentrations in survivors and non-survivors, in the sepsis status groups, and in the sepsis severity groups. Optimal cut-off values for serum NGAL concentrations to diagnose sepsis and outcome were determined with receiver operating characteristic (ROC) curves. NGAL was compared to creatinine and SAA. RESULTS Median serum NGAL concentrations were significantly higher in septic than non-septic foals. However, serum NGAL concentrations did not differ between sepsis severity subgroups. Serum NGAL concentrations were significantly lower in survivors than in non-survivors. Optimal cut-off values of serum NGAL concentrations were 455 μg/L (sensitivity 71.4%, specificity 100%) and 1104 μg/L (sensitivity 39.3%, specificity 95.2%) for predicting sepsis and non-survival, respectively. NGAL correlated to SAA, but not to creatinine. NGAL performed similarly to SAA to diagnose sepsis. CONCLUSION Serum NGAL concentrations may be useful for diagnosing sepsis and predicting outcome.
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Affiliation(s)
- Malene Laurberg
- Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia
| | - Claude Saegerman
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Stine Jacobsen
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
| | - Lise C Berg
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
| | - Sigrid Hyldahl Laursen
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
| | - Emma Hoeberg
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
| | - Elaine Alexandra Sånge
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
| | - Gaby van Galen
- Sydney School of Veterinary Science, University of Sydney, Camden, NSW, Australia
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiège), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
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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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Bedenice D, Avila B, Paradis MR. Comparative evaluation of clinical findings and prognostic outcome parameters in hospitalized, critically ill neonatal foals and crias. J Vet Emerg Crit Care (San Antonio) 2021; 31:619-628. [PMID: 34324773 DOI: 10.1111/vec.13093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Species-related differences in the prevalence, manifestation, and outcome of neonatal illness may impact management practices of neonatal intensive care. The study aimed to elucidate similarities between disease manifestations and mortality risks of critically ill (CI) neonatal crias and foals admitted to the same referral center. DESIGN A comparative, retrospective cohort evaluation of two species (camelid and equine). SETTING The study was conducted in a University hospital. ANIMALS Two hundred and forty-six CI neonatal crias (January 1999 to May 2016) and 356 neonatal foals (February 2001 to May 2016) under 4-week-old were admitted to a university hospital. INTERVENTION All data are presented descriptively and compared between groups using univariate and multivariate analyses. MEASUREMENTS AND MAIN RESULTS Female crias (142/246, 57.7%) were significantly overrepresented in comparison to fillies (132/352, 37.5%). Congenital defects and transfer failure of passive immunity were more often observed in neonatal crias, while colic, diarrhea, patent urachus, septic arthritis, and omphalitis were significantly more common in CI foals. Overall survival to discharge (excluding fatal congenital defects) was comparable between crias (174/224; 77.8%) and foals (287/347, 82.1%), while crias (26/48; 54.2%) were more likely than foals (21/60; 35%) to die naturally than undergo euthanasia. Lower respiratory disease and indications for oxygen or IV glucose support increased mortality in the multivariate outcome models of both species. Species-specific adaptations of pediatric diagnostic criteria for sepsis were significantly associated with mortality in the multivariate analysis of patients with complete hematological datasets. However, the diagnosis of systemic inflammatory response syndrome (SIRS) did not retain statistical significance as an independent outcome predictor. CONCLUSIONS Lower respiratory disease and oxygen or glucose dysregulation increased mortality irrespective of species. However, despite species-specific differences in disease prevalence, the success of intensive care management was comparable.
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Affiliation(s)
- Daniela Bedenice
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Bailey Avila
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
| | - Mary Rose Paradis
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, North Grafton, Massachusetts
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Lindegaard C, Galen G, Aarsvold S, Berg LC, Verwilghen D. Haematogenous septic arthritis, physitis and osteomyelitis in foals: A tutorial review on pathogenesis, diagnosis, treatment and prognosis. Part 1. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- C. Lindegaard
- Department of Veterinary Clinical Sciences Faculty of Health Sciences University of Copenhagen Taastrup Denmark
| | - G. Galen
- School of Veterinary Sciences Faculty of Science University of Sydney Sydney New South Wales Australia
| | - S. Aarsvold
- Puchalski Equine Imaging Petaluma California USA
| | - L. C. Berg
- Department of Veterinary Clinical Sciences Faculty of Health Sciences University of Copenhagen Taastrup Denmark
| | - D. Verwilghen
- School of Veterinary Sciences Faculty of Science University of Sydney Sydney New South Wales Australia
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Cunneen A, Wood KA, Mathison K, Herndon AM, Bertin FR. Comparison of a continuous indwelling glucometer with a point-of-care device in healthy adult horses. Vet Rec 2020; 187:e21. [PMID: 32179578 DOI: 10.1136/vr.105607] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 02/11/2020] [Accepted: 02/22/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Blood glucose is tightly regulated in horses; however, since hypoglycaemia and hyperglycaemia are associated with poor prognosis, close monitoring is warranted. This study aimed at evaluating a continuous indwelling glucometer (CIG) by comparing performance with a point-of-care glucometer (POC). METHODS Ten horses were equipped with CIG and an intravenous catheter. Interstitial glucose concentrations were determined by CIG every 5 min at rest, during insulin-induced hypoglycaemia and dextrose-induced hyperglycaemia, and compared with blood glucose determined by POC. Glucose concentrations were compared by two-way repeated measures analysis of variance and weighted kappa with Bland-Altman plots to determine agreement between assays. RESULTS Horses tolerated CIG well; however, five devices had to be replaced. There were no statistically significant differences between assays at rest or during hyperglycaemia; however, during hypoglycaemia, glucose concentrations determined by CIG were significantly higher (P=0.01). The mean bias (95% limits of agreement) between assays ranged from -0.03 (-2.46 to 2.52) mmol/l (hyperglycaemia) to 0.97 (-1.23 to 3.16) mmol/l (hypoglycaemia). Assay agreement was 'good' with observed agreements of 87.04% (κ=0.67). CONCLUSIONS OF THE STUDY CIG has acceptable accuracy in horses as compared with POC but overestimates glucose concentrations during hypoglycaemia and requires frequent replacement, limiting its clinical application.
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Affiliation(s)
- Alexandra Cunneen
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Kelly A Wood
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Kylie Mathison
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Aaron M Herndon
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
| | - Francois R Bertin
- School of Veterinary Science, The University of Queensland, Gatton, Queensland, Australia
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Bohlin A, Saegerman C, Hoeberg E, Sånge A, Nostell K, Durie I, Husted L, Öhman A, van Galen G. Evaluation of the foal survival score in a Danish-Swedish population of neonatal foals upon hospital admission. J Vet Intern Med 2019; 33:1507-1513. [PMID: 31004404 PMCID: PMC6524090 DOI: 10.1111/jvim.15487] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND It is highly desirable to assess the probability of survival in sick neonatal foals upon admission. The foal survival score (FSS) is a published scoring system used to estimate the probability of survival in hospitalized neonatal foals <4 days old. HYPOTHESIS/OBJECTIVES To evaluate the ability of the FSS to predict survival in older foals from a geographically different area compared to the original study. ANIMALS Five-hundred ninety hospitalized neonatal foals ≤14 days of age. METHODS Retrospective Danish-Swedish multicenter study that included details of signalment, history, clinical examination, laboratory results, necropsy findings, and outcome. Scores and score variables were compared between survivors and nonsurvivors using logistic regression. The optimal cutoff and its test parameters were calculated using a receiver operator characteristic curve. RESULTS Prematurity, cold extremities, ≥2 infectious or inflammatory sites, blood glucose concentration, and total white blood cell counts were significantly associated with nonsurvival (P ≤ .02). The optimal cutoff to predict survival was ≥6, resulting in sensitivity 78%, specificity 58%, 92% positive predictive value, and 31% negative predictive value. The test performed equally well in foals <4 days old compared to those 4-14 days old. CONCLUSIONS AND CLINICAL IMPORTANCE Using the suggested optimal cutoff of ≥6, the FSS performed moderately well and may aid in early determination of prognosis for survival. However, the FSS did perform differently in another population and therefore should be assessed under local conditions so that its diagnostic potential is not overestimated.
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Affiliation(s)
- Anna Bohlin
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden
| | - Claude Saegerman
- Faculty of Veterinary Medicine, Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULg), Fundamental and Applied Research for Animal and Health (FARAH) Center, University of Liege, Liege, Belgium
| | - Emma Hoeberg
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Alexandra Sånge
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
| | - Katarina Nostell
- Department of Clinical Sciences, Swedish University of Agricultural Sciences, Ultuna, Sweden
| | - Inge Durie
- Evidensia Equine Specialist Hospital Strömsholm, Strömsholm, Sweden
| | | | - Anna Öhman
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden
| | - Gaby van Galen
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark
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