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Scalco R, de Oliveira GN, da Rosa Curcio B, Wooten M, Magdesian KG, Hidai ST, Pandit P, Aleman M. Red blood cell distribution width to platelet ratio in neonatal foals with sepsis. J Vet Intern Med 2023; 37:1552-1560. [PMID: 37306395 PMCID: PMC10365058 DOI: 10.1111/jvim.16793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/26/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND Rapid and accurate markers to aid diagnosis of sepsis are needed in neonatal foals. The CBC variable red blood cell distribution width (RDW) to platelet ratio (RPR) is associated with inflammatory response and linked to poor outcomes of sepsis in human patients. HYPOTHESIS Explore the correlation of RPR with sepsis in neonatal foals and evaluate RPR predictive and prognostic value. ANIMALS Three hundred seventeen hospitalized neonatal foals ≤7 days of age that had a CBC and physical exam performed at admission between 2012 and 2021. METHODS Retrospective case-control study. Clinical records were used to calculate sepsis scores and define groups. Red blood cell distribution width to platelet ratio was calculated and compared between groups (septic vs nonseptic) based on Kruskal-Wallis and Wilcoxon signed-rank tests. A multivariate logistic regression model to predict sepsis was created. The cutoff for RPR was obtained based on the maximal Youden Index. The Kaplan-Meier method and the log-rank test were used to estimate survival curves and compare survival rates based on RPR. RESULTS Red blood cell distribution width to platelet ratio was significantly higher in septic foals (Median = 0.099, confidence interval [CI] [0.093; 0.108]) than in sick nonseptic (0.085, CI [0.083; 0.089]) and healthy foals (0.081, CI [0.077; 0.086]; P < .0001). Red blood cell distribution width to platelet ratio was able to predict sepsis with high accuracy (AUC = 82.1%). The optimal RPR cutoff for sepsis was 0.09. CONCLUSIONS AND CLINICAL IMPORTANCE Red blood cell distribution width to platelet ratio calculation is practical, inexpensive, and based on CBC-derived data. Calculation of RPR along with CBC can aid in the diagnosis of sepsis and estimation of outcome.
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Affiliation(s)
- Rebeca Scalco
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
- Present address:
Department of Pathology & Laboratory MedicineSchool of Medicine, University of CaliforniaSacramentoCaliforniaUSA
| | - Gabriela Novo de Oliveira
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Bruna da Rosa Curcio
- Department of Veterinary Clinics, School of Veterinary MedicineUniversidade Federal de Pelotas‐RSPelotasBrazil
| | - McCaide Wooten
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
- Present address:
Faculty of Veterinary MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Gary Magdesian
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Stephanie Takako Hidai
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Pranav Pandit
- EpiCenter for Disease Dynamics, One Health Institute, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
| | - Monica Aleman
- Department of Medicine and Epidemiology, School of Veterinary MedicineUniversity of CaliforniaDavisCaliforniaUSA
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Johnson K, Peterson J, Kopper J, Dembek K. The hypothalamic-pituitary-adrenal axis response to ovine corticotropin-releasing-hormone stimulation tests in healthy and hospitalized foals. Vet Med (Auckl) 2023; 37:292-301. [PMID: 36651191 PMCID: PMC9889673 DOI: 10.1111/jvim.16604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 11/23/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND The hypothalamic-pituitary-adrenocortical axis (HPAA) response to sepsis can be impaired in critical illness. Corticotropin-releasing hormone (CRH) stimulation test might assess HPAA function in foals. OBJECTIVE To evaluate plasma cortisol, ACTH, arginine vasopressin (AVP), and endogenous CRH (eCRH) response to different doses of ovine CRH (oCRH). ANIMALS Healthy (n = 14) and hospitalized (n = 15) foals <7 days of age. METHODS In this prospective randomized study, oCRH (0.1, 0.3, and 1 μg/kg) was administered intravenously and blood samples were collected before, 15, 30, 60, and 90 minutes after administration of oCRH to determine plasma hormone concentrations. The hormonal response was evaluated as the difference (Delta; μg/dL or pg/mL) or percent change between baseline hormone concentration and each time point after oCRH stimulation. RESULTS Cortisol concentrations increased from baseline at 15 minutes with 0.1 and 0.3 μg/kg and at 30 and 60 minutes from baseline with 1 μg/kg oCRH (P < .05) in healthy and hospitalized foals. ACTH concentrations increased from baseline at 15 minutes with 0.1 μg/kg and at 30 minutes with 1 μg/kg oCRH (P < .05) in hospitalized foals. Delta cortisol 0 - 30, ACTH 0 - 30, and eCRH 0 - 30 was higher for the 1 μg/kg compared with 0.1 μg/kg oCRH in healthy foals (P < .05). Delta ACTH 0 - 15 and eCRH 0 - 30 was higher for the 1 μg/kg compared with the lower doses of oCRH in hospitalized foals (P < .05). CONCLUSIONS AND CLINICAL IMPORTANCE Cortisol, ACTH, and eCRH concentrations increased in response to administration of all doses of oCRH. One microgram per kilogram of oCRH appears to be optimal for the assessment of HPAA in healthy and hospitalized foals.
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Affiliation(s)
- Katheryn Johnson
- Department of Veterinary Clinical SciencesIowa State University College of Veterinary MedicineAmesIowaUSA
| | - Jackie Peterson
- Department of Veterinary Clinical SciencesIowa State University College of Veterinary MedicineAmesIowaUSA
| | - Jamie Kopper
- Department of Veterinary Clinical SciencesIowa State University College of Veterinary MedicineAmesIowaUSA
| | - Katarzyna Dembek
- Department of Clinical SciencesNorth Carolina State University College of Veterinary MedicineRaleighNorth CarolinaUSA
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3
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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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4
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Biomarkers of sepsis in pigs, horses and cattle: from acute phase proteins to procalcitonin. Anim Health Res Rev 2022; 23:82-99. [PMID: 35795920 DOI: 10.1017/s1466252322000019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Sepsis is a complex clinical syndrome triggered by an inflammatory host response to an infection. It is usually complicated to detect and diagnose, and has severe consequences in human and veterinary health, especially when treatment is not started early. Therefore, efforts to detect sepsis accurately are needed. In addition, its proper diagnosis could reduce the misuse of antibiotics, which is essential fighting against antimicrobial resistance. This case is a particular issue in farm animals, as antibiotics have been traditionally given massively, but now they are becoming increasingly restricted. When sepsis is suspected in animals, the most frequently used biomarkers are acute phase proteins such as C-reactive protein, serum amyloid A and haptoglobin, but their concentrations can increase in other inflammatory conditions. In human patients, the most promising biomarkers to detect sepsis are currently procalcitonin and presepsin, and there is a wide range of other biomarkers under study. However, there is little information on the application of these biomarkers in veterinary species. This review aims to describe the general concepts of sepsis and the current knowledge about the biomarkers of sepsis in pigs, horses, and cattle and to discuss possible advances in the field.
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Borba LDA, Nogueira CEW, Bruhn FRP, da Silva GC, Feijó LS, Canisso IF, Curcio BDR. Peripheral blood markers of sepsis in foals born from mares with experimentally induced ascending placentitis. Vet Rec 2021; 187:29. [PMID: 33638540 DOI: 10.1136/vr.104710] [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: 09/15/2017] [Revised: 12/18/2019] [Accepted: 02/22/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Neonatal sepsis is a leading cause of neonatal death during the first-week postfoaling. Despite recent advancements in the diagnosis and treatment of sepsis in the newborn foal, the non-specific clinical signs and subtle nature of this disease may result in delayed diagnosis until severe progression of the disease; thus, early detection of sepsis remains critical for a favourable outcome. This study aimed to identify early blood markers as predictive of sepsis on foals. METHODS Thirty-five foals were allocated into three groups: healthy control foals (n=7) and foals born from mares with placentitis: septic foals (n=9) and non-septic foals (n=19). Blood samples were obtained immediately after foaling and at 12, 24 and 48 hours. All samples were assessed for glucose, lactate, triglycerides, total cholesterol, urea, creatinine, total solids, fibrinogen, gamma-glutamyl transferase (GGT), serum amyloid A (SAA) and alpha-fetoprotein (AFP) concentrations. RESULTS At foaling, glucose and GGT concentrations were lower in septic foals (P<0.001). Of interest, SAA, AFP, creatinine and total cholesterol were higher in septic foals at parturition (P<0.05). At 12 hours, lactate, triglycerides and total cholesterol concentrations were higher in septic foals. When evaluated at 24 and 48 hours, higher concentrations of SAA and AFP were found in placentitis foals than in the control group. CONCLUSIONS Total cholesterol and lactate appear to be suitable markers for sepsis during the first 24 hours postpartum. Septic foals displayed altered energy metabolisms as determined by increased triglycerides and cholesterol concentrations, hypoglycaemia at birth and reduced activity of the GGT and increased lactate and urea concentrations. Sepsis was associated with high concentrations of SAA and AFP.
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Affiliation(s)
- Luciana de Araujo Borba
- Departamento de Clínicas Veterinária, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fábio Raphael Pascoti Bruhn
- Departamento de Medicina Veterinária Preventiva, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Gabriela Castro da Silva
- Departamento de Clínicas Veterinária, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Lorena Soares Feijó
- Departamento de Clínicas Veterinária, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Igor F Canisso
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois Urbana-Champaign, Urbana, IL, USA
| | - Bruna da Rosa Curcio
- Departamento de Clínicas Veterinária, Faculdade de Veterinária, Universidade Federal de Pelotas, Pelotas, Brazil
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6
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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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de Barros ADMC, Silva AFR, Zibordi M, Spagnolo JD, Corrêa RR, Belli CB, de Camargo MM. Equine simplified acute physiology score: Personalised medicine for the equine emergency patient. Vet Rec 2021; 189:e136. [PMID: 33729604 DOI: 10.1002/vetr.136] [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: 09/29/2020] [Revised: 12/11/2020] [Accepted: 01/26/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Scoring models are useful tools that guide the attending clinician in gauging the severity of disease evolution and in evaluating the efficacy of treatment. There are few tools available with this purpose for the non-human patient, including horses. We aimed (i) to adapt the simplified acute physiology score 3 (SAPS-3) model for the equine species, reaching a margin of accuracy greater than 75% in the calculation of the probability of survival/death and (ii) to build a decision tree that helps the attending veterinarian in assessment of the clinical evolution of the equine patient. METHODS From an initial pool of 5568 medical records from University-based Veterinary Hospitals, a final cohort of 1000 was further mined manually for data extraction. A set of 19 variables were evaluated and tested by five machine learning data mining algorithms. RESULTS The final scoring model, named EqSAPS for equine simplified acute physiology score, reached 91.83% of correct estimates (post hoc) for probability of death within 24 hours upon hospitalization. The area under receiver operating characteristic curve for outcome 'death' was 0.742, while for 'survival' was 0.652. The final decision tree was able to refine prognosis of patients whose EqSAPS score suggested 'death'. CONCLUSION EqSAPS is a useful tool to gauge the severity of the clinical presentation of the equine patient.
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Affiliation(s)
| | - Ana Flávia Rocha Silva
- School of Zootechnics and Food Engineering, University of São Paulo, Pirassununga, Brazil
| | - Miriam Zibordi
- School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
| | - Julio David Spagnolo
- Veterinary Hospital, Large Animals Surgery Section, School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
| | - Rodrigo Romero Corrêa
- Department of Surgery, School of Veterinary Medicine, University of São Paulo, São Paulo, Brazil
| | - Carla B Belli
- Department of Clinics, School of Veterinary Medicine, University of São 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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Sanmartí J, Armengou L, Viu J, Alguacil E, Civit S, Ríos J, Jose-Cunilleras E. Plasma iron concentrations and systemic inflammatory response syndrome in neonatal foals. J Vet Intern Med 2020; 34:1325-1331. [PMID: 32297679 PMCID: PMC7255657 DOI: 10.1111/jvim.15770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Sparse information regarding plasma iron concentration in neonatal foals and its utility as an inflammatory marker in this population has been published. OBJECTIVES To determine the physiologic plasma iron concentration in neonatal foals. To assess its utility as an inflammatory marker to predict systemic inflammatory response syndrome (SIRS) and as a prognostic marker. ANIMALS Forty-seven ill neonatal foals admitted to a referral equine hospital were divided in 2 groups based on the SIRS criteria (24 SIRS and 23 non-SIRS). Two control groups of 43 hospital and 135 stud farm healthy neonatal foals were also included. METHODS Observational prospective study. Data were summarized by mean and its 95% confidence interval and absolute frequency and percentage for quantitative andqualitative variables. One-way ANOVA, ANCOVA (group and age effects) and Dunnett as posthoc analysis were used to compare plasma iron concentration among groups. RESULTS Neonatal foals with SIRS did not have had any statistically significant different plasma iron concentrations compared to non-SIRS (P = .56) and stud farm control group (P = .99), 172.8 μg/dL (95% CI; 126.0-219.6), 193.1 μg/dL (139.1-247.2), and 181.8 μg/dL (171.3-192.4), respectively. Plasma iron concentration had a large variability in healthy neonatal foals, and was negatively correlated with age in hospital controls (rho = -0.387) and sick neonatal foals (rho = -0.598) (P < .001). CONCLUSIONS AND CLINICAL IMPORTANCE Plasma iron was not a useful marker of SIRS in neonatal foals and was not associated with outcome.
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Affiliation(s)
- Júlia Sanmartí
- Servei de Medicina Interna Equina, Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.,Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Lara Armengou
- Servei de Medicina Interna Equina, Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.,Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Judit Viu
- Servei de Medicina Interna Equina, Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Veterinario Sierra de Madrid, 28750-San Agustín de Guadalix, Madrid, Spain
| | - Eduardo Alguacil
- Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain.,Uplands Way Vets Low Road, Bressingham, IP22 2AA Diss, Norfolk, UK
| | | | - José Ríos
- Unitat de Bioestadística, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduard Jose-Cunilleras
- Servei de Medicina Interna Equina, Departament de Medicina i Cirurgia Animals, Facultat de Veterinària, Universitat Autònoma de Barcelona, Barcelona, Spain.,Unitat Equina, Fundació Hospital Clínic Veterinari, Universitat Autònoma de Barcelona, Barcelona, Spain
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11
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Duncan NB, Johnson PJ, Crosby MJ, Meyer AM. Serum Chemistry and Hematology Changes in Neonatal Stock-Type Foals During the First 72 Hours of Life. J Equine Vet Sci 2020; 84:102855. [PMID: 31864462 DOI: 10.1016/j.jevs.2019.102855] [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: 06/19/2019] [Revised: 07/28/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Abstract
Limited research has characterized blood chemistry in healthy stock-type foals. Our objectives were to determine foal serum chemistry and hematology changes during the first 72 hours postnatal and compare these with adult horse reference ranges. Over 3 foaling seasons, serum chemistry and hematology were determined for 16 healthy stock-type foals born to similarly managed mares. Blood was collected at 0 hours (before nursing but after standing, within 85 minutes of birth) and 6, 12, 24, 48, and 72 hours after initial sampling. Data were analyzed with sampling hour, year, and their interaction as fixed effects. Serum glucose and triglyceride concentrations increased (P < .001) from 0 to 24 hours. Triglycerides increased (P < .001) and glucose decreased (P = .01) between 24 to 48 hours. Serum nonesterified fatty acids increased (P = .04) from 0 to 6 hours and decreased (P ≤ .01) from 6 to 24 hours. Serum urea nitrogen increased (P < .001) between 0 and 6 hours and decreased (P < .001) from 12 to 72 hours. Serum total protein and globulin concentrations increased (P < .001) from 0 to 12 hours, albumin decreased (P ≤ .01) from 0 to 24, and creatinine decreased (P ≤ .02) from 0 to 72 hours. Hour also affected (P ≤ .03) electrolytes, metabolic enzymes, and all hematological components except for mean corpuscular hemoglobin (P = .77). These data demonstrate dynamic blood biochemical and hematological changes throughout the first 72 hours in foals, suggesting that sampling time should be considered when evaluating individual neonates.
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Affiliation(s)
- Natalie B Duncan
- Division of Animal Sciences, University of Missouri, Columbia, MO
| | - Philip J Johnson
- Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO
| | - Marci J Crosby
- Division of Animal Sciences, University of Missouri, Columbia, MO
| | - Allison M Meyer
- Division of Animal Sciences, University of Missouri, Columbia, MO.
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12
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Lausch CK, Lorch A, Giertzuch S, Rieger A, Knubben-Schweizer G, Trefz FM. Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies. J Dairy Sci 2019; 103:1856-1865. [PMID: 31759607 DOI: 10.3168/jds.2019-17224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 09/28/2019] [Indexed: 02/02/2023]
Abstract
In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.
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Affiliation(s)
- C K Lausch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - A Lorch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - S Giertzuch
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - A Rieger
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - G Knubben-Schweizer
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany
| | - F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Centre for Clinical Veterinary Medicine, Ludwig-Maximilians-Universität (LMU) Munich, Sonnenstrasse 16, 85764 Oberschleißheim, Germany; Clinic for Ruminants, Vetsuisse-Faculty, University of Bern, Bremgartenstrasse 109a, 3012 Bern, Switzerland.
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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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14
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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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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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Altan S, Koç Y, Alkan F, Sayın Z, Erol M. Impact of bacterial translocation in calves with atresia coli. J Vet Emerg Crit Care (San Antonio) 2018; 28:261-268. [PMID: 29608243 DOI: 10.1111/vec.12709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 06/29/2017] [Accepted: 08/17/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To identify whether enteric bacteria pass into the mesenteric lymph nodes (MLNs) and peritoneal cavity in calves with atresia coli and to evaluate whether the presence of bacterial translocation (BT) has an impact on the success of surgical treatment. DESIGN Prospective clinical study. ANIMALS Twenty-six client-owned calves. INTERVENTIONS During laparotomy, swab samples were collected from the peritoneal cavity and MLNs using a sterile swab stick and were submitted for microbiological analysis. MEASUREMENTS AND MAIN RESULTS Bacterial cultures of swab samples revealed that 65% (n = 17) of the calves experienced BT. Of these, 14 calves experienced BT to the MLNs, 9 to the peritoneal cavity, and 5 to both regions. Of the bacteria isolated from the MLNs, 72% (n = 10) were Escherichia coli. Of the samples isolated from the peritoneal fluid, 33% (n = 3) contained E. coli and 33% (n = 3) contained E. coli + coagulase-negative Staphylococcus (CNS). In calves with BT that were discharged (n = 13) and without BT that were discharged (n = 7), the median survival was 30 days; these data were found to be similar in the 2 groups. CONCLUSIONS This study revealed that BT is observed in the majority of atresia coli cases. E. coli is more common in BT, and translocation occurs primarily through the lymphatic route. These results suggest that the presence of BT is closely related to the success of the operation for correction of atresia coli.
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Affiliation(s)
- Semih Altan
- Faculty of Veterinary Medicine, Department of Surgery, University of Dicle, 21280, Diyarbakır, Turkey (Altan)
| | - Yılmaz Koç
- Faculty of Veterinary Medicine, Department of Surgery (Koç and Alkan)
| | - Fahrettin Alkan
- Faculty of Veterinary Medicine, Department of Surgery (Koç and Alkan)
| | - Zafer Sayın
- Department of Microbiology (Sayın), University of Selçuk, 42075 Konya, Turkey
| | - Muharrem Erol
- Faculty of Veterinary Medicine, Department of Surgery, University of Balıkesir, 10145 Balıkesir, Turkey (Erol)
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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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19
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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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20
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Shea EK, Dombrowski SC, Silverstein DC. Survival analysis of hypotensive cats admitted to an intensive care unit with or without hyperlactatemia: 39 cases (2005-2011). J Am Vet Med Assoc 2017; 250:887-893. [PMID: 28358631 DOI: 10.2460/javma.250.8.887] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the association between blood lactate concentration and survival to hospital discharge in critically ill hypotensive cats. DESIGN Retrospective case series. ANIMALS 39 cats admitted to an intensive care unit of a university veterinary hospital between January 2005 and December 2011 for which blood lactate concentration was recorded ≤ 1 hour before or after a Doppler-derived arterial blood pressure measurement ≤ 90 mm Hg (ie, hypotension) was obtained. PROCEDURES Medical records of each cat were reviewed to assess survival to hospital discharge, illness severity, duration of hospitalization, age, body weight, and PCV. Results were compared between hypotensive cats with and without hyperlactatemia (blood lactate concentration ≥ 2.5 mmol/L). RESULTS 6 of 39 (15%) hypotensive cats survived to hospital discharge. Twelve (31%) cats were normolactatemic (blood lactate concentration < 2.5 mmol/L), and 27 (69%) were hyperlactatemic. Hypotensive cats with normolactatemia had a higher blood pressure and higher survival rate than hypotensive cats with hyperlactatemia. Five-day Kaplan-Meier survival rates were 57% for normolactatemic cats and 17% for hyperlactatemic cats. Age, body weight, duration of hospitalization, PCV, and illness severity did not differ significantly between hypotensive cats with and without hyperlactatemia. CONCLUSIONS AND CLINICAL RELEVANCE Hypotensive, normolactatemic cats in an intensive care unit had a significantly greater chance of survival to hospital discharge than their hyperlactatemic counterparts. Blood lactate concentration may be a useful prognostic indicator for this patient population when used in conjunction with other clinical and laboratory findings.
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21
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Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea. PLoS One 2017; 12:e0182938. [PMID: 28817693 PMCID: PMC5560544 DOI: 10.1371/journal.pone.0182938] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/26/2017] [Indexed: 01/09/2023] Open
Abstract
Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. The mortality rate was 22%. Classification tree analysis indicated that mortality was associated with clinical signs of neurologic disease, abdominal emergencies, cachexia, orthopedic problems such as septic arthritis, and profound acidemia (jugular venous blood pH < 6.85). When exclusively considering laboratory parameters, classification tree analysis identified plasma glucose concentrations < 3.2 mmol/L, plasma sodium concentrations ≥ 151 mmol/L, serum GGT activity < 31 U/L and a thrombocyte count < 535 G/L as predictors of mortality. However, multivariable logistic regression models based on these laboratory parameters did not have a sufficiently high enough sensitivity (59%) and specificity (79%) to reliably predict treatment outcome. The sensitivity and specificity of jugular venous blood pH < 6.85 were 11% and 97%, respectively, for predicting non-survival in this study population. We conclude that laboratory values (except jugular venous blood pH < 6.85) are of limited value for predicting outcome in critically ill neonatal calves with diarrhea. In contrast, the presence of specific clinical abnormalities provides valuable prognostic information.
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Niimura Del Barrio MC, Bennett RC, Hughes JML. Effect of detomidine or romifidine constant rate infusion on plasma lactate concentration and inhalant requirements during isoflurane anaesthesia in horses. Vet Anaesth Analg 2017; 44:473-482. [PMID: 28462846 DOI: 10.1016/j.vaa.2016.01.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 01/15/2016] [Accepted: 01/29/2016] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Influence of detomidine or romifidine constant rate infusion (CRI) on plasma lactate concentration and isoflurane requirements in horses undergoing elective surgery. STUDY DESIGN Prospective, randomised, blinded, clinical trial. ANIMALS A total of 24 adult healthy horses. METHODS All horses were administered intramuscular acepromazine (0.02 mg kg-1) and either intravenous detomidine (0.02 mg kg-1) (group D), romifidine (0.08 mg kg-1) (group R) or xylazine (1.0 mg kg-1) (group C) prior to anaesthesia. Group D was administered detomidine CRI (10 μg kg-1 hour-1) in lactated Ringer's solution (LRS), group R romifidine CRI (40 μg kg-1 hour-1) in LRS and group C an equivalent amount of LRS intraoperatively. Anaesthesia was induced with ketamine and diazepam and maintained with isoflurane in oxygen. Plasma lactate samples were taken prior to anaesthesia (baseline), intraoperatively (three samples at 30 minute intervals) and in recovery (at 10 minutes, once standing and 3 hours after end of anaesthesia). End-tidal isoflurane percentage (Fe'Iso) was analysed by allocating values into three periods: Prep (15 minutes after the start anaesthesia-start surgery); Surgery 1 (start surgery-30 minutes later); and Surgery 2 (end Surgery 1-end anaesthesia). A linear mixed model was used to analyse the data. A value of p<0.05 was considered significant. RESULTS There was a difference in plasma lactate between 'baseline' and 'once standing' in all three groups (p<0.01); values did not differ significantly between groups. In groups D and R, Fe'Iso decreased significantly by 18% (to 1.03%) and by 15% (to 1.07%), respectively, during Surgery 2 compared with group C (1.26%); p<0.006, p<0.02, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Intraoperative detomidine or romifidine CRI in horses did not result in a clinically significant increase in plasma lactate compared with control group. Detomidine and romifidine infusions decreased isoflurane requirements during surgery.
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Affiliation(s)
- M C Niimura Del Barrio
- Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland.
| | - Rachel C Bennett
- Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland
| | - J M Lynne Hughes
- Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Belfield, Dublin, Ireland
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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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Mizen K, Woodman J, Boysen SR, Wagg C, Greco-Otto P, Léguillette R, Roy MF. Effect of Dexamethasone on Resting Blood Lactate Concentrations in Horses. J Vet Intern Med 2016; 31:164-169. [PMID: 28019037 PMCID: PMC5259638 DOI: 10.1111/jvim.14630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 09/12/2016] [Accepted: 11/08/2016] [Indexed: 11/28/2022] Open
Abstract
Background Blood lactate concentration is a marker of tissue perfusion and helps guide therapeutic interventions in critically ill horses. In both humans and dogs, administration of corticosteroids can increase blood lactate concentration, leading to type B hyperlactatemia. This effect could be a consequence of the impact of corticosteroids on glucose metabolism. Objectives To investigate the effects of daily IM dexamethasone administration on blood lactate and glucose concentrations in horses. Animals Nine healthy adult horses. Methods A randomized, blinded, controlled, cross‐over study design was used. Horses were randomly assigned to 1 of 2 groups, either receiving 0.05 mg/kg of dexamethasone IM or an equivalent volume of saline, daily for 7 days. Blood was collected to determine lactate and glucose concentrations at baseline, 2 hours after the daily injections and 24 hours after the last injection. Results Dexamethasone treatment had a statistically significant effect on lactate (P = .006) and glucose (P = .033) concentrations. The least squares mean lactate concentration was 0.93 mmol/L (95% CI: 0.87–0.99) in the dexamethasone group compared to 0.71 mmol/L (95% CI: 0.70–0.73) for the saline group. A positive relationship between blood lactate and glucose concentrations was identified, with a 0.07 mmol/L (95% CI: 0.05–0.09) increase in lactate concentration per unit increase in glucose (P < .0001) concentration. Conclusions and Clinical Importance Dexamethasone induces statistically significant increases in blood lactate and glucose concentrations in healthy horses. Awareness of the potential for corticosteroids to induce type B hyperlactatemia might be important in the management of critically ill horses receiving dexamethasone.
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Affiliation(s)
- K Mizen
- Northside Veterinary Clinic, Lethbridge, AB, Canada
| | - J Woodman
- Alpine Pet Hospital, Calgary, AB, Canada
| | - S R Boysen
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, AB, Canada
| | - C Wagg
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, AB, Canada
| | - P Greco-Otto
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, AB, Canada
| | - R Léguillette
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, AB, Canada
| | - M-F Roy
- Faculty of Veterinary Medicine, Department of Veterinary Clinical and Diagnostic Sciences, University of Calgary, Calgary, AB, Canada
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Nye CJ, Musulin SE, Hanel RM, Mariani CL. Evaluation of the Lactate Plus monitor for plasma lactate concentration measurement in dogs. J Vet Emerg Crit Care (San Antonio) 2016; 27:66-70. [PMID: 27973760 DOI: 10.1111/vec.12557] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 01/26/2015] [Accepted: 03/09/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To compare the Lactate Plus handheld monitor to a reference blood gas analyzer for determining plasma lactate concentrations in canine whole blood. DESIGN Prospective observational study. SETTING University teaching hospital. ANIMALS Ninety-four dogs hospitalized or admitted through the emergency service provided 125 blood samples. Only dogs that required a venous or arterial blood gas evaluation as a part of their diagnostic assessment or ongoing management were included. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Canine whole blood samples were assayed for plasma lactate concentration with a reference blood gas analyzer and the Lactate Plus monitor. Correlation and Bland-Altman analyses were used to compare results between the 2 methods. A subset of blood samples was repeatedly analyzed with the Lactate Plus to assess monitor precision. Plasma lactate measurements from the Lactate Plus monitor showed excellent correlation with those from the reference analyzer (ρ = 0.98, P < 0.0001). Bland-Altman analysis revealed a small bias (0.1296). Agreement between the 2 methods was less consistent for lactate concentrations >5 mmol/L. The coefficient of variation ranged from 0-26.2% (median, 3.7%) and was <15% for 50/53 samples. CONCLUSIONS The Lactate Plus provides a fast and affordable method to measure plasma lactate concentration in dogs. Results showed excellent agreement with the reference analyzer and precision of the instrument was acceptable.
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Affiliation(s)
- Carolyn J Nye
- Comparative Neuroimmunology and Neurooncology Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607
| | - Sarah E Musulin
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607
| | - Rita M Hanel
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607
| | - Christopher L Mariani
- Comparative Neuroimmunology and Neurooncology Laboratory, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607.,Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, 27607
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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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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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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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Salciccia A, Grulke S, de la Rebière de Pouyade G, Franck T, Detilleux J, Serteyn D, Sandersen C. Assessment of systemic inflammation by time-trends of blood granulocyte count and plasma myeloperoxidase and elastase concentrations following colic surgery in horses. J Vet Emerg Crit Care (San Antonio) 2016; 26:541-8. [PMID: 27147114 DOI: 10.1111/vec.12481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 11/08/2014] [Accepted: 11/29/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine changes in blood granulocyte counts and in plasma myeloperoxidase (MPO) and elastase (ELT) concentrations in surgical colic cases, and to determine the relationship between these changes and the surgical procedure performed, occurrence of postoperative ileus, and final outcome. DESIGN Prospective clinical study conducted over a 12-month period. SETTING University teaching hospital. ANIMALS Fifty-three horses undergoing emergency laparotomy and surviving at least 12 hours postoperatively. INTERVENTIONS Blood samples were taken before surgery, during surgery, at the recovery from anesthesia, and then serially until the 150th hour after the first blood sampling. Granulocyte counts were performed by an automated cell hematology analyzer. Specific ELISAs were performed for the MPO and ELT measurements. Mixed models were used to compare the time-trends of the 3 parameters. MEASUREMENTS AND MAIN RESULTS Taking all horses together, the time-trends of MPO and ELT were not significantly different from each other, but they were significantly different from the granulocyte time-trend. The type of surgical procedure did not influence the time-trends of the 3 parameters. Significant changes in the granulocyte time-trends were associated with postoperative ileus and outcome. Significant changes in the MPO time-trends were associated with outcome. The ELT time-trends were not influenced by ileus or outcome. CONCLUSIONS Granulocyte counts and MPO change over time and are related to the severity of the inflammatory reaction in surgical colic cases. These time-trends may allow evaluation of treatment efficacy in an effort to modulate excessive granulocyte activation and degranulation.
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Affiliation(s)
- Alexandra Salciccia
- Faculty of Veterinary Medicine, Department of Companion Animals and Horses, University of Liège, Liège, 4000, Belgium.,the Center for Oxygen Research and Development, University of Liège, Liège, 4000, Belgium
| | - Sigrid Grulke
- Faculty of Veterinary Medicine, Department of Companion Animals and Horses, University of Liège, Liège, 4000, Belgium.,the Center for Oxygen Research and Development, University of Liège, Liège, 4000, Belgium
| | - Geoffroy de la Rebière de Pouyade
- Faculty of Veterinary Medicine, Department of Companion Animals and Horses, University of Liège, Liège, 4000, Belgium.,the Center for Oxygen Research and Development, University of Liège, Liège, 4000, Belgium
| | - Thierry Franck
- the Center for Oxygen Research and Development, University of Liège, Liège, 4000, Belgium
| | - Johann Detilleux
- the Faculty of Veterinary Medicine, Quantitative Genetics, University of Liège, Liège, 4000, Belgium
| | - Didier Serteyn
- Faculty of Veterinary Medicine, Department of Companion Animals and Horses, University of Liège, Liège, 4000, Belgium.,the Center for Oxygen Research and Development, University of Liège, Liège, 4000, Belgium
| | - Charlotte Sandersen
- Faculty of Veterinary Medicine, Department of Companion Animals and Horses, University of Liège, Liège, 4000, Belgium.,the Center for Oxygen Research and Development, University of Liège, Liège, 4000, Belgium
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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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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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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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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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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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Daniel AJ, Leise BS, Burgess BA, Morley PS, Cloninger M, Hassel DM. Concentrations of serum amyloid A and plasma fibrinogen in horses undergoing emergency abdominal surgery. J Vet Emerg Crit Care (San Antonio) 2015; 26:344-51. [PMID: 26274017 DOI: 10.1111/vec.12365] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 05/20/2014] [Accepted: 07/10/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the perioperative response of serum amyloid A (SAA) to fibrinogen in horses requiring exploratory celiotomy for colic and to determine if SAA could be used to predict complications and outcome. DESIGN Prospective observational clinical study. SETTING University teaching hospital. ANIMALS Eighteen horses undergoing exploratory celiotomy for colic. Inclusion criteria for the study included survival and anesthetic recovery from exploratory celiotomy, no history of surgery within the past year. INTERVENTIONS Blood was obtained via jugular venipuncture before surgery (time 0) and at 24, 48, 72, and 96 hours after recovery from anesthesia. MEASUREMENTS AND MAIN RESULTS Quantitative and semiquantitative fibrinogen, SAA, total nucleated cell counts, and total protein were evaluated at each time point. Multivariable linear regression was used to assess differences at each time point and after grouping horses according to duration of colic prior to surgery, strangulating surgical lesion or not, presence of systemic inflammatory response syndrome (SIRS) on admission, and postsurgical complications. Significant (P < 0.05) increases in SAA concentrations occurred in all cases after surgery compared to fibrinogen concentration, which only demonstrated a mild, clinically insignificant increase postsurgery. SAA concentrations were also significantly increased (P < 0.05) in cases identified with SIRS prior to surgery and postoperatively at 48 (P = 0.05) and 72 hours (P = 0.02) in horses that developed complications. CONCLUSIONS Measurement of SAA is a more sensitive indicator of inflammation than fibrinogen in the perioperative period of horses requiring exploratory celiotomy for colic. Serial measurement of SAA at 48, 72, and 96 hours after surgery may be helpful to determine risk of complications and guide postoperative management. Measurement of SAA on admission also allows for quantification of SIRS when it is detected clinically.
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Affiliation(s)
- Alexander J Daniel
- Department of Clinical Sciences, College of Veterinary and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523
| | - Britta S Leise
- Department of Clinical Sciences, College of Veterinary and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523
| | - Brandy A Burgess
- Department of Clinical Sciences, College of Veterinary and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523
| | - Paul S Morley
- Department of Clinical Sciences, College of Veterinary and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523
| | - Madison Cloninger
- Department of Clinical Sciences, College of Veterinary and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523
| | - Diana M Hassel
- Department of Clinical Sciences, College of Veterinary and Biomedical Sciences, Colorado State University, Fort Collins, CO, 80523
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Bonelli F, Meucci V, Divers T, Radcliffe R, Jose-Cunilleras E, Corazza M, Guidi G, Tognetti R, Castagnetti C, Intorre L, Sgorbini M. Evaluation of Plasma Procalcitonin Concentrations in Healthy Foals and Foals Affected by Septic Systemic Inflammatory Response Syndrome. J Equine Vet Sci 2015. [DOI: 10.1016/j.jevs.2015.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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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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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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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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Sgorbini M, Bonelli F, Rota A, Marmorini P, Biagi G, Corazza M, Pasquini A. Maternal and neonatal evaluation of derivated reactive oxygen metabolites (d-ROMs) and biological antioxidant potential in the horse. Theriogenology 2015; 83:48-51. [DOI: 10.1016/j.theriogenology.2014.07.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 07/14/2014] [Accepted: 07/15/2014] [Indexed: 10/24/2022]
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Dembek KA, Hurcombe SD, Frazer ML, Morresey PR, Toribio RE. Development of a likelihood of survival scoring system for hospitalized equine neonates using generalized boosted regression modeling. PLoS One 2014; 9:e109212. [PMID: 25295600 PMCID: PMC4189956 DOI: 10.1371/journal.pone.0109212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/29/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Medical management of critically ill equine neonates (foals) can be expensive and labor intensive. Predicting the odds of foal survival using clinical information could facilitate the decision-making process for owners and clinicians. Numerous prognostic indicators and mathematical models to predict outcome in foals have been published; however, a validated scoring method to predict survival in sick foals has not been reported. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission. METHODS AND RESULTS Data from 339 hospitalized foals of less than four days of age admitted to three equine hospitals were included to develop the model. Thirty seven variables including historical information, physical examination and laboratory findings were analyzed by generalized boosted regression modeling (GBM) to determine which ones would be included in the survival score. Of these, six variables were retained in the final model. The weight for each variable was calculated using a generalized linear model and the probability of survival for each total score was determined. The highest (7) and the lowest (0) scores represented 97% and 3% probability of survival, respectively. Accuracy of this survival score was validated in a prospective study on data from 283 hospitalized foals from the same three hospitals. Sensitivity, specificity, positive and negative predictive values for the survival score in the prospective population were 96%, 71%, 91%, and 85%, respectively. CONCLUSIONS The survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be easily implemented using data available in most equine hospitals. GBM was a useful tool to develop the survival score. Further evaluations of this scoring system in field conditions are needed.
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Affiliation(s)
- Katarzyna A. Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Samuel D. Hurcombe
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Michele L. Frazer
- Hagyard Equine Medical Institute, Lexington, Kentucky, United States of America
| | - Peter R. Morresey
- Rood and Riddle Equine Hospital, Lexington, Kentucky, United States of America
| | - Ramiro E. Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
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43
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Armstrong SK, Raidal SL, Hughes KJ. Fibrinous pericarditis and pericardial effusion in three neonatal foals. Aust Vet J 2014; 92:392-9. [DOI: 10.1111/avj.12238] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- SK Armstrong
- School of Animal and Veterinary Sciences; Charles Sturt University; Locked Bag 588 Wagga Wagga New South Wales 2678 Australia
| | - SL Raidal
- School of Animal and Veterinary Sciences; Charles Sturt University; Locked Bag 588 Wagga Wagga New South Wales 2678 Australia
| | - KJ Hughes
- School of Animal and Veterinary Sciences; Charles Sturt University; Locked Bag 588 Wagga Wagga New South Wales 2678 Australia
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44
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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: 19] [Impact Index Per Article: 1.9] [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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45
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Moore JN, Vandenplas ML. Is it the systemic inflammatory response syndrome or endotoxemia in horses with colic? Vet Clin North Am Equine Pract 2014; 30:337-51, vii-viii. [PMID: 25016495 DOI: 10.1016/j.cveq.2014.04.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Some veterinarians describe particularly sick horses or neonatal foals as being endotoxemic, whereas others refer to the same animals as having the systemic inflammatory response syndrome. This article reviews the basis for the use of each of these terms in equine practice, and highlights the mechanisms underlying the response of the horse's innate immune system to key structural components of the microorganisms that initiate these conditions, including how some of those responses differ from other species. Current approaches used to treat horses with these conditions are summarized, and caution advised on extrapolating findings from other species to the horse.
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Affiliation(s)
- James N Moore
- Department of Large Animal Medicine, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA 30602, USA; Department of Physiology and Pharmacology, College of Veterinary Medicine, University of Georgia, 501 DW Brooks Drive, Athens, GA 30602, USA.
| | - Michel L Vandenplas
- Ross University School of Veterinary Medicine, PO Box 334, Basseterre, Saint Kitts, West Indies
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46
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Toth B, Slovis NM, Constable PD, Taylor SD. Plasma adrenomedullin concentrations in critically ill neonatal foals. J Vet Intern Med 2014; 28:1294-300. [PMID: 24773029 PMCID: PMC4857949 DOI: 10.1111/jvim.12358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/05/2014] [Accepted: 03/12/2014] [Indexed: 11/17/2022] Open
Abstract
Background Bacterial sepsis remains a leading cause of morbidity and mortality in neonatal foals, but accurate diagnostic and prognostic markers are lacking. Adrenomedullin (AM) is a polypeptide with diverse biologic effects on the cardiovascular system that increases in septic humans and laboratory animals. Hypotheses Plasma AM concentration (p[AM]) is increased in septic neonatal foals compared to sick nonseptic and healthy control foals, and p[AM] is predictive of survival in septic neonatal foals. Animals Ninety critically ill (42 septic, 48 sick nonseptic) and 61 healthy foals <1 week of age. Methods A prospective observational clinical study was performed. Venous blood was collected from critically ill foals at admission and from healthy foals at 24 hours of age. Critically ill foals were categorized as septic or sick nonseptic based on blood culture results and sepsis score. Plasma [AM] was measured by using a commercially available ELISA for horses. Data were analyzed by using the Mann‐Whitney U‐test and P < .05 was considered significant. Results Plasma [AM] was not significantly different between septic and sick nonseptic foals (P = .71), but critically ill foals had significantly increased p[AM] compared to healthy controls (P < .0001). In critically ill foals, p[AM] was not predictive of survival (P = .051). A p[AM] cutoff concentration of 0.041 ng/mL provided a test sensitivity of 91% and specificity of 54% to predict illness. Conclusions and Clinical Relevance Plasma [AM] shows promise as a marker of health in neonatal foals, but p[AM] increases nonspecifically during perinatal illnesses and is not necessarily associated with sepsis.
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Affiliation(s)
- B Toth
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN
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47
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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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48
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Nelson BB, Lordan EE, Hassel DM. Risk factors associated with gastrointestinal dysfunction in horses undergoing elective procedures under general anaesthesia. Equine Vet J 2013:8-14. [DOI: 10.1111/evj.12162] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
Affiliation(s)
- B. B. Nelson
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; USA
| | - E. E. Lordan
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; USA
| | - D. M. Hassel
- Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences; Colorado State University; USA
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49
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Abstract
Abnormalities of insulin metabolism include hyperinsulinaemia and insulin resistance, and these problems are collectively referred to as insulin dysregulation in this review. Insulin dysregulation is a key component of equine metabolic syndrome: a collection of endocrine and metabolic abnormalities associated with the development of laminitis in horses, ponies and donkeys. Insulin dysregulation can also accompany prematurity and systemic illness in foals. Causes of insulin resistance are discussed, including pathological conditions of obesity, systemic inflammation and pituitary pars intermedia dysfunction, as well as the physiological responses to stress and pregnancy. Most of the discussion of insulin dysregulation to date has focused on insulin resistance, but there is increasing interest in hyperinsulinaemia itself and insulin responses to feeding. An oral sugar test or in-feed oral glucose tolerance test can be performed to assess insulin responses to dietary carbohydrates, and these tests are now recommended for use in clinical practice. Incretin hormones are likely to play an important role in postprandial hyperinsulinaemia and are the subject of current research. Insulin resistance exacerbates hyperinsulinaemia, and insulin sensitivity can be measured by performing a combined glucose-insulin test or i.v. insulin tolerance test. In both of these tests, exogenous insulin is administered and the rate of glucose uptake into tissues measured. Diagnosis and management of hyperinsulinaemia is recommended to reduce the risk of laminitis. The term insulin dysregulation is introduced here to refer collectively to excessive insulin responses to sugars, fasting hyperinsulinaemia and insulin resistance, which are all components of equine metabolic syndrome.
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Affiliation(s)
- N Frank
- Department of Clinical Sciences, Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts, USA; Division of Veterinary Medicine, School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, Leicestershire, UK
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50
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Karapinar T, Kaynar O, Hayirli A, Kom M. Evaluation of 4 point-of-care units for the determination of blood l-lactate concentration in cattle. J Vet Intern Med 2013; 27:1596-603. [PMID: 24118259 DOI: 10.1111/jvim.12204] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 06/19/2013] [Accepted: 08/20/2013] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Despite being used commonly in bovine medicine, information on reliability of point-of-care (POC) lactate meters is limited. OBJECTIVE To determine the validity of 4 commercially available POC lactate meters in cattle. ANIMALS Cattle with various diseases (n = 120). METHODS Blood samples collected from the jugular vein were processed immediately on POC lactate meters. Plasma l-lactate concentration was measured by the enzymatic-colorimetric method (ELISA). Data were subjected to Friedman's test for comparison, Passing-Bablok regression and Bland-Altman plot analyses for reliability, and receiver operating characteristics analysis for sensitivity (Se) and specificity (Sp). RESULTS The POC lactate meters were highly correlated with ELISA (r = 0.98-0.99) despite disagreements among units. When regressed on ELISA, blood l-lactate concentrations generated from Accutrend Plus and Lactate Pro were linear up to 16.6 and 15.7 mmol/L, respectively, whereas those generated from i-STAT and Lactate Scout were linear up to 19.5 and 19.7 mmol/L, respectively. All POC lactate meters had a Se of 100% with Sp of 95.7-98.6% at a plasma l-lactate cut-off concentration of 4 mmol/L. i-STAT had the best accuracy (99.0%) and precision (99.8%), the best linear fit (y = -0.13 + 1.04X) yielding the lowest bias (-6.6%) as well as the highest Se (100%) and Sp (98.6%). CONCLUSIONS AND CLINICAL IMPORTANCE Despite high correlation with the reference method, dilution is needed for Accutrend Plus/Lactate Pro and i-STAT/Lactate Scout if concentrations >15 and 20 mmol/L, respectively. i-STAT provided the most accurate and precise results.
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Affiliation(s)
- T Karapinar
- Faculty of Veterinary Medicine, Department of Internal Medicine, Firat University, Elazig, Turkey
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