Red blood cell distribution width to platelet ratio in neonatal foals with sepsis

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.

Adaptation and acceptability testing of the Expector® vibration vest in horses

The project is based on a test of a thoracic vibration vest prototype, adapted to equines by the Expector® vest’s company, on healthy animals. Ten (10) equines were used in the project, male or female, adults, healthy, belonging to FMVZUSP or private owners. Each animal went through two phases: A and B. Phase A consisted of the placement of the vest without turning on the vibrators, evaluating the animal’s acceptability, facility, adaptation to the animal’s body, and discomfort due to the vest’s use. Phase B included the placement of the vest and turning on the vibrators, evaluating the animal’s acceptability, reaction to the vibrators, and, if present, to which velocity/type of vibration, and the presence of adverse effects. Both phases were done three times on separate days. The behavioral parameters: “placement facility” and “adaptation to the animal’s body” were observed. In phase B, the response to the vibration was classified from 0 to 5. The answer was evaluated on low and high intensities for the four vibration types. The heart rate (HR) and respiratory rate (RR) were also evaluated at the beginning and end of each repetition. The animals’ HR was kept on normal, except for one animal on one day of the test. Concerning the RR, most animals presented moments of tachypnea. On the experiment’s first day, 100% of grade Great to “facility of placement” and “adaptation to the animal’s body” was obtained, but on days 2 and 3 this value dropped to 90% due to alterations in one animal’s responses. Regarding vibration’s responses, 77.3% were evaluated as no discomfort (grade 0), 17.1% little discomfort (grade 1), 3.3% medium discomfort (grade 2), 0.4% great discomfort (grade 3), 0.21% extreme discomfort (grade 4), and 1.6% non-acceptance of the vest (grade 5). Some possible changes on the prototype were also verified to be suggested to the manufacturer, such as the change of the buckle and the use of wireless control. Vest use appears promising for equine respiratory physiotherapy, considering the acceptability was good, and its efficiency on the expectoration of diseased animals must be tested.