Donatienne Castelain, Mathilde Laetitia Pas, Marcin Skotarek, Filip Boyen, Bart Pardon, Dominique Paepe
Sepsis was confirmed in 29 of 130 critically ill dogs (22.3%), and 18 died, with a short-term mortality rate of 62.1%. Pneumonia (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.8-13.1; P = .002) and acute kidney injury (AKI; OR = 7.4; 95% CI = 2.2-25.1; P = .001) were associated with sepsis. Multivariable logistic regression identified dyspnea (OR = 6.5; 95% CI = 1.6-26.0; P = .01), respiratory rate (≥38 per minute; OR = 3.9; 95% CI = 1.1-13.1; P = .03), and alanine aminotransferase activity (≥109.5 U/L; OR = 3.8; 95% CI = 1.1-12.8; P = .03) as risk factors for sepsis. When combined, these factors yielded a sensitivity of 35.0% and specificity of 92.8%. The CART analysis identified body weight, tachypnea, hypotension, hyperchloremia, hyperlactatemia, and hyponatremia as risk factors for sepsis (sensitivity, 58.6%; specificity, 97.0%). The APPLE FAST score (OR = 2.9; 95% CI = 1.2-7.1; P = .02) was associated with sepsis. The APPLE FAST score (OR = 3.2; 95% CI = 1.4-7.2; P = .01) was the strongest predictor of mortality.
BACKGROUND: Being a life-threatening syndrome, rapid detection of sepsis in critically ill dogs is mandatory.
HYPOTHESIS/OBJECTIVES: Determine risk factors associated with sepsis in critically ill dogs and evaluate diseases and scoring systems associated with sepsis or mortality.
ANIMALS: One hundred thirty critically ill dogs.
METHODS: Prospective single-center cohort study. Logistic regression and classification and regression tree (CART) analysis were performed to assess clinical and laboratory variables as risk factors for sepsis. Diagnostic and prognostic performance of available scoring systems was evaluated.
RESULTS: Sepsis was confirmed in 29 of 130 critically ill dogs (22.3%), and 18 died, with a short-term mortality rate of 62.1%. Pneumonia (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.8-13.1; P = .002) and acute kidney injury (AKI; OR = 7.4; 95% CI = 2.2-25.1; P = .001) were associated with sepsis. Multivariable logistic regression identified dyspnea (OR = 6.5; 95% CI = 1.6-26.0; P = .01), respiratory rate (≥38 per minute; OR = 3.9; 95% CI = 1.1-13.1; P = .03), and alanine aminotransferase activity (≥109.5 U/L; OR = 3.8; 95% CI = 1.1-12.8; P = .03) as risk factors for sepsis. When combined, these factors yielded a sensitivity of 35.0% and specificity of 92.8%. The CART analysis identified body weight, tachypnea, hypotension, hyperchloremia, hyperlactatemia, and hyponatremia as risk factors for sepsis (sensitivity, 58.6%; specificity, 97.0%). The APPLE FAST score (OR = 2.9; 95% CI = 1.2-7.1; P = .02) was associated with sepsis. The APPLE FAST score (OR = 3.2; 95% CI = 1.4-7.2; P = .01) was the strongest predictor of mortality.
CONCLUSIONS AND CLINICAL IMPORTANCE: Pneumonia and AKI were associated with sepsis. Identified risk factors may guide veterinarians in the rapid recognition of sepsis. The APPLE FAST score was associated with sepsis and mortality and may support diagnostic and therapeutic decision-making for critically ill dogs with sepsis.