Evaluating the clinical utility of the systemic inflammatory response syndrome criteria in dogs and cats presenting to an emergency department

OBJECTIVE

Evaluate the clinical utility of the systemic inflammatory response syndrome (SIRS) criteria in dogs and cats presenting to an emergency room (ER).

DESIGN

Prospective and retrospective observational study, conducted from November 2019 to February 2020.

SETTING

Small animal university teaching hospital.

ANIMALS

Prospective enrollment of 1143 dogs and 384 cats consecutively presenting to the ER. Retrospective enrollment of 65 healthy dogs and 57 healthy cats consecutively presenting to the primary care (PC) service.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

Positive SIRS-3 status was defined as meeting ≥2 of 3 (dogs) or 3 of 3 (cats) of the vital parameter SIRS criteria (temperature, heart rate, and respiratory rate). Positive SIRS-4 status was defined as meeting ≥2 of 4 (dogs) and ≥3 of 4 (cats) of the vital parameter and CBC SIRS criteria. For each species, proportions of SIRS-positive animals were compared between the ER and PC groups. Clinical outcomes were compared between SIRS-positive and SIRS-negative patients presenting to ER. The number of SIRS-3-positive dogs was statistically but not clinically different between the ER (69.9%) and PC (53.8%) groups (P = 0.009). Overall survival rate was 83% for SIRS-3-positive and 89% for SIRS-3-negative dogs presented to ER (P = 0.007). The number of SIRS-3-positive cats did not differ between ER and PC groups (P > 0.999). Overall survival rate was 61.1% for SIRS-4-positive and 86.8% for SIRS-4-negative cats presented to ER (P = 0.012).

CONCLUSIONS

Fulfilling the SIRS criteria is common in dogs and rare in cats regardless of presenting service. Meeting SIRS criteria on ER presentation carries a weak negative survival association in dogs and a moderate negative survival association in cats. This study demonstrates that the SIRS criteria have poor discriminatory ability to differentiate healthy from diseased patients and lacks a strong outcome correlation in small animal patients.

Clinical features, outcomes, and long-term survival times of cats and dogs with central nervous system cryptococcosis in Australia: 50 cases (2000-2020)

OBJECTIVE

To describe the clinical findings and outcomes of Australian cats and dogs with CNS cryptococcosis.

ANIMALS

19 cats and 31 dogs with CNS cryptococcosis diagnosed between 2000 and 2020.

PROCEDURES

A case series and cohort study were performed using the same 50 animals. Both studies were multi-institutional and both retrospective and prospective. Disease features were compared between cats and dogs, and associations between putative risk factors and survival time (ST) were assessed.

RESULTS

Dogs were younger at initial presentation than cats and had lower latex cryptococcal antigen agglutination titers. Extraneurologic signs were common and frequently involved sinonasal and contiguous tissues. Neuroanatomic localization was predominantly forebrain, central vestibular (including cerebellum), multifocal, or diffuse. CSF analysis predominantly showed pleocytosis, with eosinophilic inflammation common in dogs. Seventy-eight percent (39/50) of patients received antifungal treatment. Median STs (from presentation) in treated patients were 1,678 days for cats and 679 days for dogs. Abnormal mentation at presentation (in dogs) and CSF collection (in cats) were associated with shorter STs. In treated dogs, those that received glucocorticoids prior to diagnosis, or single rather than multiple antifungal agents, had shorter STs.

CLINICAL RELEVANCE

The prognosis for feline and canine CNS cryptococcosis is guarded, yet long STs are possible with appropriate treatment. Presence of subtle upper respiratory tract signs may suggest cryptococcosis in patients with neurologic signs, while the absence of neurologic signs does not preclude CNS involvement.

Resolution of Severe Neurologic Signs Following Intravenous Lipid Emulsion Therapy in a Young Dog With a Portosystemic Shunt: Case Report

A 5-month-old male intact Great Pyrenees was presented for an acute onset of severe neurologic signs (stupor, absent menace, intermittent head turn to the left). The patient's history included possible naproxen ingestion with a maximum ingested dose of 59 mg/kg, exceeding the reported dose of >50 mg/kg known to cause neurologic signs. Blood sampling for baseline bloodwork was performed, and intravenous lipid emulsion (ILE) was subsequently administered, for treatment of the suspected toxicosis. Due to severe and life-threatening neurologic signs, other methods of decontamination were contraindicated and unlikely to be effective; extracorporeal therapy was also unavailable. Complete resolution of neurologic signs occurred 30 min after completion of ILE therapy. At this time, the owners found the missing naproxen tablets after returning home and the bloodwork results returned revealing findings consistent with hepatic encephalopathy. The fasted blood ammonia concentration immediately prior to ILE administration was 702.1 μg/dL (reference interval, RI: 24–36 μg/dL) and decreased to 194.1 μg/dL 24 h later. In the first 24 h, the patient also received three doses of lactulose, N-acetylcysteine, and intravenous fluids. The patient was subsequently diagnosed with a single, large intrahepatic portosystemic shunt via computed tomography and underwent an endovascular coil embolization procedure. Given the rapid and dramatic improvement in severe neurologic signs after ILE therapy alone, it is strongly suspected that this treatment resulted in improvement of hepatic encephalopathy.