Association between Hyperglycemia and Survival in 228 Horses with Acute Gastrointestinal Disease

Background: Glucose homeostasis is dysregulated in critically ill humans resulting in hyperglycemia and decreased survival. Hyperglycemia is common in horses presenting with abdominal crisis, and this might be associated with a worse prognosis for survival.
Objective: To determine if hyperglycemia in horses with acute abdominal disease is associated with increased odds of failure to survive to hospital discharge.
Animals: Two hundred and twenty-eight adult horses with acute gastrointestinal disease.
Methods: Observational retrospective study. Records of horses > 1 year of age presenting for treatment of colic over a 3-year period were reviewed. Data collected included age, duration of colic, glucose, heart rate, PCV, total protein, anion gap, cost of hospitalization, breed, sex, pain at admission, diagnosis, whether surgery was performed, and life status at hospital discharge. Potential risk factors for nonsurvival were screened by univariable logistic regression and the best-fitting univariable model was used as the basis for multivariable regression modeling.
Results: Mean blood glucose was 155 mg/dL (8.5 mM) with 45% of the population above the reference range; 16.7% (38 of 228) of horses had severe hyperglycemia (>195 mg/dL; 10.7 mM). Factors associated with increased odds of failure to survive included glucose, severity of pain at admission, heart rate, PCV, anion gap, and diagnosis. The best-fitting multivariable model included glucose and diagnosis, with age included as a confounding variable. The model correctly classified outcome for 92.5% of horses.
Conclusions and Clinical Importance: This study has confirmed prior reports that hyperglycemia is common in horses with colic and is associated with a worse prognosis for survival to hospital discharge.     

Tumor Necrosis Factor and Interleukin-6 Activity and Endotoxin Concentration in Peritoneal Fluid and Blood of Horses with Acute Abdominal Disease

The purpose of this study was to evaluate the diagnostic and prognostic significance of tumor necrosis factor-alpha (TNF) and interleukin-6 (IL-6) activities and endotoxin concentration in blood and peritoneal fluid of 155 adult horses with acute abdominal disease (colic). Samples also were obtained from 20 healthy adult horses. Blood and peritoneal fluid supernatant TNF and IL-6 activities and endotoxin concentration were significantly greater in horses with colic, compared with healthy horses. In horses with colic, the peritoneal fluid endotoxin concentration and TNF and IL-6 activities were significantly greater than those in blood. Within the colic group, peritoneal fluid IL-6 activity was the analyte that was most frequently increased. Blood and peritoneal fluid supernatant TNF and IL-6 activities were significantly greater when endotoxin was detected in the same sample. Blood and peritoneal fluid IL-6 activity was significantly greater in horses with inflammatory or strangulating lesions, compared with horses having nonstrangulating or noninflammatory lesions. Compared with all other data categories, diagnostic accuracy for nonsurvival was greatest (80%) when blood IL-6 activity exceeded 60 units/mL. The results of this study indicate that endotoxin was present in the peritoneal cavity of at least one third of horses with any acute disease of the abdomen. In horses presented for colic, blood or peritoneal fluid IL-6 activity was more useful than either TNF activity or endotoxin concentration for distinguishing lesion type. Although diagnostic accuracy for the prediction of nonsurvival was good for all of the analytes, negative values were more useful in the prediction of a favorable outcome than were abnormally increased values in the prediction of mortality.     

Retrospective Identification of Bacterial Isolates From Emergency Laparotomy Surgical Site Infections in Horses

Surgical site infection (SSI) with multiresistant bacteria is an important cause of postoperative morbidity after laparotomy in horses. The objective of this study was to identify bacteria isolates and their antibiotic resistance patterns associated with the development of wound infection in horses after laparotomy. This is a retrospective case series. Medical records of horses that underwent ventral midline exploratory laparotomy in a four-year period at one equine hospital were reviewed. Results of microbiologic culture and susceptibility testing are described. The study group consisted of 183 (100%) horses that recovered from anesthesia after laparotomy. The prevalence of infection was 19% (24/124) after first surgery and 83% (19/23) after relaparotomy. The most common microbial isolates were bacteria of the family Enterobacteriaceae followed by Staphylococcus ssp., Enterococcus ssp., Streptococcus ssp., and Bacteroides ssp. Bacteria from the family Enterobacteriaceae showed the lowest resistance to amphenicols, cephalosporins, and quinolones groups of antibiotics. Coagulase-positive Staphylococci were sensitive to amphenicols and only 33% were resistant to trimethoprim/sulfamethoxazole. The most commonly used perioperative and postoperative antibiotics were gentamicin and amoxicillin. Limitations include poor control over exposure factors, covariates, and potential confounders during the surgery, recovery time, or period of hospitalization; relying on others for accurate outcome assessment and recordkeeping; lack of follow-up information once animals were discharged from the hospital. Despite 5 days of antibiotic prophylaxis, the rate of incisional infection is still high. The most common isolates from SSI belong to the family Enterobacteriaceae and the genus Staphylococcus, which showed high resistance to the antibiotics used before the gastrointestinal surgery.     

Association between hypercoagulability and decreased survival in horses with ischemic or inflammatory gastrointestinal disease

Background: Coagulopathies are common in horses with ischemic or inflammatory gastrointestinal (GI) disturbances. There is indirect evidence suggesting that early stages of these diseases are characterized by hypercoagulability (HC). Hypothesis/Objectives: HC, assessed via thromboelastography (TEG), is common in horses with ischemic or inflammatory GI diseases. The degree of HC is correlated with nonsurvival and thrombotic complications. Animals: Thirty client‐owned horses with ischemic or inflammatory GI disease, 30 client‐owned horses with nonischemic or inflammatory GI disease, and 30 healthy horses (control group). Methods: Prospective, observational clinical study. TEG profiles of 30 horses with ischemic or inflammatory GI disease were obtained on admission and 48 hours after admission, and these were compared with profiles from 30 horses with nonischemic or inflammatory GI disease and 30 healthy controls. Prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin activity (AT), and D‐Dimer concentrations were also determined in horses with GI disease. Results: Horses with ischemic or inflammatory GI disease had shorter R times compared with healthy horses (14.8 ± 8.3 versus 22.8 ± 12 minute; P= .011). However, changes were subtle and TEG profiles did not resembled those obtained from animals or humans presumed to be hypercoagulable. Although conventional coagulation testing supported the presence of HC (decreased AT and increased D‐Dimer concentrations), TEG and coagulation abnormalities were rarely found in the same horses and the methods were not statistically related. Conclusions and Clinical Importance: There is evidence of HC in horses with GI disease but techniques for diagnoses require refinement.     

A Fresh Look at the Process of Arriving at a Clinical Prognosis Part 2: Colic

Generating an accurate prognosis in a horse with colic involves identifying and determining the severity of homeostatic derangements, particularly aberrations in cardiorespiratory, metabolic, and hemostatic functions. The basic questions to be answered are as follows: How sick is the horse?, How healthy was he to begin with?, and How well has he responded to treatment? Although laboratory data are very helpful in making such determinations, a thorough physical examination can suffice if necessary, particularly when repeated to obtain serial data. By reframing the serious colic case in terms of how the horse’s system is responding—or failing—as a whole in its attempts to restore homeostasis, we are better equipped to act preemptively or promptly enough to avert a fatal result and to ensure minimal short- and long-term complications.     

Colic Surgery in Horses: A Retrospective Study Into Short- and Long-Term Survival Rate,Complications and Rehabilitation toward Sporting Activity

Colic surgery in horses impacts both short-term well-being of horses due to possible surgical and anesthetic complications and also long-term return to a sporting career. In this retrospective study, survival and complication rates, as well as functional outcome and behavioral problems in horses that underwent colic surgery were studied. Data from 283 horses that underwent colic surgery at a veterinary teaching hospital were analyzed. Furthermore, owners were contacted and requested to fill out a questionnaire concerning the first year of rehabilitation. Of 283 horses that underwent colic surgery, 167 (59%) were discharged home. After discharge from hospital, 34 horses (12%) were lost to follow-up. Of the remaining 133 horses, 128 were still alive after 1 year (96.2%), while 5 horses were euthanized due to recurrent colic. Of the horses that did not survive the hospitalization period 73 horses (25.8%) were euthanized intraoperatively and 36 horses (12.7%) during intensive care unit (ICU) stay. Survival of horses entering the ICU up to discharge from hospital was 79.5%. During rehabilitation, 49 horses (59.8%) that returned home experienced one or more recurrences of colic. Fifty-two horses (63.4%) that returned home reached at least preoperative level of performance. Altered behavior and gait-related problems during specific elements of riding (for instance during collecting, lateral bending, etc.) were reported in up to 46.2% of horses. Improving veterinary aftercare in collaboration with other disciplines (e.g., physiotherapy and saddle fitting) during rehabilitation could be a means to further improve athletic performance and welfare after recovery from colic surgery.     

Evaluation of Equine Albumin Solution in Fluid Therapy in Horses with Colic

Equine albumin solution can be a good therapeutic option in fluid replacement for treatment of horses with colic. The purpose of this study was to evaluate the effects of initial fluid therapy with equine albumin solution in horses presenting with colic and mild-to-moderate dehydration, and to compare this therapy with fluid therapy based on crystalloids alone. Nineteen horses of both genders presenting with colic and mild-to-moderate dehydration were used. Animals were randomly assigned to one of two groups (control: fluid therapy based on crystalloid solutions; experimental: fluid therapy based on equine albumin and crystalloid solutions). Physical examination, hematocrit determination, blood gas analysis, serum biochemistry, blood and peritoneal lactate assessment, and measurement of colloid osmotic and arterial pressure were performed at predetermined times. Good results were obtained with equine albumin solution. More fluid is attracted into and maintained in the intravascular compartment, despite infusion of small volumes, as indicated by higher arterial pressure, lower capillary refill time, lower hematocrit and serum protein concentrations, lower colloid osmotic pressure, and better skin turgor. Equine albumin solution has good oncotic action and is a safe fluid therapy option for horses with colic and mild-to-moderate dehydration. Our results suggest it can be a good choice of fluid for correction of severe dehydration, although further research is necessary to determine the adequate dose in such cases.     

Using Artificial Intelligence to Predict Survivability Likelihood and Need for Surgery in Horses Presented With Acute Abdomen (Colic)

Artificial intelligence and machine learning have promising applications in several medical fields of diagnosis, imaging, and laboratory testing procedures. However, the use of this technology in the veterinary medicine field is lagging behind, and there are many areas where it could be used with potentially successful outcomes and results. In this study, two critical predictions were explored in horses presented with acute abdomen (colic) using this technology. Those were the need for surgical intervention and survivability likelihood of affected horses based on clinical data (history, clinical examination findings, and diagnostic procedures). The two prediction parameters were explored using the application of Decision Trees, Multilayer Perceptron, Bayes Network, and Naïve Bayes. The machine learning algorithms were able to predict the need for surgery and survivability likelihood of horses presented with acute abdomen (colic) with 76% and 85% accuracy, respectively. The application of this technology in the different clinical fields of veterinary medicine appears to be of a value and warrants further investigation and testing.     

Cardiac arrhythmias and electrolyte disturbances in colic horses

Background

Despite increased focus on cardiac arrhythmias in horses, the nature and prevalence is still poorly described. Case reports suggest that arrhythmias occurring secondary to systemic disease are seen more commonly in the clinic than arrhythmias caused by cardiac disease. The aim of this study was to investigate the prevalence of arrhythmias in colic horses referred for hospital treatment. Associations between electrolyte disturbances and arrhythmias were also investigated.The study population consisted of eight control horses and 22 referred colic horses. A Holter electrocardiography (ECG) was recorded during the first 24 hours of admission. The ECG’s were analysed by a software program followed by manual visual inspection. Arrhythmias registered included second degree atrioventricular (AV) blocks, supraventricular premature complexes (SVPCs), and ventricular premature complexes (VPCs). Blood was collected at admission and again between 12 and 24 hours after ECG was applied, and analysed for concentrations of potassium, sodium, ionised calcium, chloride, glucose, and L-lactate.

Results

Heart rate was 37.4 ± 3.7 bpm in the control group, and 51.6 ± 11.8 bpm, in the colic group, which was significantly different (P < 0.0001). AV blocks and SVPCs were found in both groups, however only colic horses showed VPCs. No significant difference between the two groups was found for AV blocks, SVPCs, and VPCs (P = 0.08 - 0.76). The mean levels of potassium, sodium, ionized calcium, and chloride were significantly lower in the colic group compared to the control group at admission. Mean levels of glucose and L-lactate were significantly elevated in the colic group (P < 0.05).

Conclusions

This study describes prevalence of cardiac arrhythmias and electrolytes concentrations in colic horses compared to healthy controls. Although we only observed VPCs in the colic horses, no significant differences between colic horses and controls were found. Despite the colic horses having electrolyte changes at admission no correlation was found between the electrolyte disturbances and cardiac arrhythmias. Although no clear conclusions can be drawn from the present study, the results indicate that relatively mild colic per se is not pro-arrhythmogenic, whereas severe colic probably are more likely to result in ventricular arrhythmia.     

Detection of fibrin deposits in tissues from horses with severe gastrointestinal disorders

BACKGROUND: In humans and experimental animals, disseminated intravascular coagulation (DIC) causes fibrin deposition in several organs, which eventually leads to ischemia and multiorgan failure. HYPOTHESIS: Horses who died or were euthanized for severe gastrointestinal disorders could have fibrin deposits in different tissues. ANIMALS: Tissue-organ samples collected during postmortem examinations on 66 colic horses with poor prognoses (eg, severe intestinal ischemia, enteritis, peritonitis), from 11 colic horses with good prognoses (eg, large-colon obstruction or displacement), and from 16 slaughter horses. METHODS: Tissue samples (kidney, lung, liver) were stained with hematoxylin and eosin, and phosphotungstic acid hematoxylin for a blinded histologic examination. A fibrin score (grades 0 to 4) was established for each tissue sample and for each horse. RESULTS: Fibrin deposits were found in tissue specimens of 11 of 27 of horses (40.7%) in the ischemic group, 8 of 21 in the enteritis group (38.1%), and 7 of 18 in the peritonitis group (39.0%), whereas none of the horses in the obstructive group (n = 11) and only 1 horse in the slaughter group (n = 16) had fibrin deposits in their tissues. In addition, the mean fibrin score values for the ischemic, enteritis, and peritonitis groups (1.3 +/- 1.7, 1.1 +/- 1.6, and 0.9 +/- 1.3, respectively) were statistically higher than those for the obstructive and slaughter groups (0.0 +/- 0.0 and 0.1 +/- 0.5, respectively). The largest fibrin deposits were found in the lungs. Conclusions and Clinical Importance: Horses with severe gastrointestinal disorders have fibrin deposits that are consistent with capillary microthrombosis, multiorgan failure, and DIC.