Survival and prognostic indicators for cycad intoxication in dogs

Background: Cycad palms are commonly used in landscaping and ingestion by dogs can cause disease or death. Objectives: Determine the morbidity and case fatality of cycad palm toxicosis in dogs from Louisiana, and examine putative prognostic factors. Animals: Thirty‐four client‐owned dogs with confirmed cycad palm toxicosis between 2003 and 2010. Methods: Retrospective cohort study. Search of all medical records for animals with cycad palm toxicosis. Results: Seventeen of 34 (50%) dogs died or were euthanized as a direct consequence of cycad intoxication. There were no differences in presenting signs and physical examination findings between survivors and nonsurvivors. Nonsurvivors had higher serum alanine transaminase activity (median 196 U/L; range 16–4,123 versus 113.5; 48–1,530) and total bilirubin concentration (0.5 mg/dL; 0.1–6.2 versus 0.25; 0–1.7) upon presentation, and their initial serum concentrations of albumin (2.9 g/dL; 1.4–4.1 versus 3.3; 2.2–3.9) were lower than those of survivors. Nadir serum albumin concentration was also lower in nonsurvivors (1.9; 1.4–3.7 versus 3.2; 1.8–3.5). A higher proportion of nonsurvivors had prolonged coagulation times, prothrombin time. and partial thromboplastin time. In a multivariate model, administration of charcoal at initial presentation was associated with longer survival (heart rate [HR] 0.019, 95% CI 0.001–0.644), while high serum aspartate aminotransferase activity was a negative prognostic factor (HR 118.2, 95% CI 2.89–4,826). Conclusions and Clinical Importance: Cycad intoxication is associated with a higher case fatality than previously published. Several laboratory parameters might help differentiating potential nonsurvivors from survivors. Administration of charcoal as part of the emergency treatment appears to have a protective effect.     

Retrospective Study: The association of blood lactate concentration with outcome in dogs with idiopathic immune‐mediated hemolytic anemia: 173 cases (2003–2006)

Objective – To determine the association of blood lactate with outcome and response to transfusion therapy in dogs with idiopathic immune‐mediated hemolytic anemia (IMHA). Design – Retrospective study. Setting – Urban veterinary small animal emergency hospital. Animals – One hundred and seventy‐three client‐owned dogs with IMHA. Interventions – None. Measurements and Main Results – Serial blood lactate concentration, therapeutic interventions, and outcome were recorded. Nonsurvivors were defined as those that died or were euthanized. One hundred and thirty‐three dogs (77%) survived, 35 (20%) were euthanized, and 5 (3%) died. One hundred forty‐five dogs (84%; 145/173) had a lactate concentration above the laboratory reference interval [0.46–2.31 mmol/L] on presentation. Blood lactate at presentation was higher in the nonsurvivors (median 4.8 mmol/L; 0.5–13.6) compared with survivors (median 2.9 mmol/L; 0.3–13.2) (P<0.01). All dogs presenting with hyperlactatemia that normalized (<2.0 mmol/L) within 6 hours of admission survived, whereas, 71% of dogs that had a persistent hyperlactatemia at 6 hours survived (P=0.034). Lactate was positively correlated with age, BUN, and alkaline phosphatase, and inversely correlated with PCV. Receiver operating curve analysis for lactate concentration at admission as a test for outcome had an area under the curve of 0.69 with an optimal lactate cutoff concentration of 4.4 mmol/L correctly predicting outcome 73% of the time (sensitivity 60%, specificity 77%). Conclusions – Lactate concentration at presentation was significantly higher in nonsurvivors than survivors. Lactate was significantly correlated with previously reported outcome variables but lactate concentration at admission, as a predictor for outcome was less than optimal. However, serial lactate concentration measurements may be more predictive as patients with persistent hyperlactatemia 6 hours after admission were less likely to survive. Prospective studies evaluating serial lactate concentration while controlling for other variables may provide further insight into lactate measurement as a prognostic indicator in animals with IMHA.     

Von Willebrand Factor Antigen Concentration in Dogs with Sepsis

Background: Von Willebrand factor (vWF) antigen concentration, a marker of endothelial activation, is increased in human patients with multiorgan failure, sepsis, or both, and is an independent predictor of survival.
Hypothesis/Objectives: vWF antigen concentrations are significantly higher in dogs with sepsis.
Animals: Fourteen dogs hospitalized with sepsis. Sepsis was defined as microbiologic or cytologic evidence of infection combined with systemic inflammatory response syndrome. Control dogs were healthy dogs, without evidence of disease.
Methods: Prospective, observational study. Dogs admitted to the intensive care unit with a diagnosis of sepsis were considered eligible for enrollment into the study. Exclusion criteria included a previous diagnosis of von Willebrand disease or a recent history of a plasma transfusion. Citrated plasma samples were collected for analysis of vWF antigen by ELISA. All samples were drawn from dogs during hospitalization. Data between populations were analyzed using nonparametric statistical analysis with a P value < .05 considered significant.
Results: Twenty-five dogs were enrolled; 14 dogs with sepsis and 11 control dogs. The median vWF antigen concentration in dogs with sepsis was 156% (range, 117–200%), which was significantly higher than healthy dogs (105%; range, 44–155%, P < .005). There was no difference between survivors and nonsurvivors with a median vWF antigen concentration of 144% (range, 136–201%) in survivors (n = 7) and 159% (range, 122–174%) in nonsurvivors (n = 7) ( P = .5).
Conclusions and Clinical Importance: vWF is increased in dogs with sepsis, possibly reflecting endothelial activation. Further exploration of endothelial function is warranted in critically ill dogs.     

Incidence and clinical relevance of hyperglycemia in critically ill dogs

BACKGROUND: Hyperglycemia associated with critical illness in nondiabetic human patients is a common occurrence in the intensive care unit (ICU), with a reported incidence as high as 71%. HYPOTHESIS: Hyperglycemia in critically ill dogs increases the risk of morbidity and mortality. ANIMALS: Two hundred forty-five dogs hospitalized in the ICU over a 2-month period were evaluated. METHODS: Prospective observational study was conducted over a 2-month period. All dogs in the ICU had their highest daily blood glucose concentration recorded. All dogs with diabetes were excluded from the study. Hyperglycemia was defined as a blood glucose concentration >120 mg/dL. Dogs with hyperglycemia were monitored for persistence and resolution of hyperglycemia. RESULTS: During the study period, 245 dogs were evaluated, of which 38 (16%) were hyperglycemic. Twenty-six percent (10/ 38) developed hyperglycemia during hospitalization, whereas 74% (28/38) were hyperglycemic at presentation. Length of hospitalization (LOH) was shorter in dogs that presented with hyperglycemia compared with those that developed hyperglycemia during hospitalization (P = .001). Seventy-one percent (27/38) of dogs were discharged from the hospital, whereas the remaining 29% (11/38) died or were euthanatized. Nonsurvivors had significantly higher median glucose concentration (median, 176 mg/dL; range 122-310 mg/dL) than did survivors (median, 139 mg/dL; 121-191 mg/dL; P = .021). CONCLUSIONS AND CLINICAL IMPORTANCE: The incidence of hyperglycemia in this population of dogs was 16%. Dogs that developed hyperglycemia had longer LOH and nonsurvivors had more pronounced hyperglycemia than did survivors.     

Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988–2006)

Objective – To determine whether the dose of antivenin administered is associated with a difference in survival of crotalid‐envenomated dogs. A secondary objective was to determine whether other covariables affect survival. Design – Retrospective study (1988–2006). Setting – Private referral center and university small animal teaching hospital. Animals – Two hundred and eighteen dogs with evidence of crotalid envenomation and treatment with equine‐derived antivenin. Interventions – Administration of antivenin. Measurements and Main Results – Patient signalment, physical and clinicopathologic data at time of presentation, treatments, complications of antivenin therapy, length and cost of hospitalization, and outcome were recorded. Confidence intervals were determined for the difference in median number of vials administered and for median dosage for patients that lived versus died. Penalized logistic regression was performed to evaluate the effect of other covariables on survival. The median age of affected dogs was 3 years (range 6 w–12 y) with a median weight of 25.7 kg (range 1.95–86.4 kg). The median number of antivenin vials administered was 1.0 (range 1.0–10.0). Acute and chronic reactions were reported in 7% (16/218) and 0.9% (2/218) of dogs, respectively. Nine of 218 dogs (4.1%) died. The median number of vials administered to the nonsurvivors and survivors were 2.0 (range 1–5 vials) and 1.0 (range 1–10 vials), respectively. The median number of vials received was significantly different in dogs that died versus those that lived (P<0.05). Increased heart rate (P=0.02) and petechiation (P=0.04) were associated with decreased likelihood of survival, while diphenhydramine (P=0.02) and fluoroquinolone (P=0.046) administration was associated with increased likelihood of survival. The median duration of hospitalization was 1.0 day (range 2 h–22 d). The median cost of hospitalization was US$1592.00 (range US$267.20–US$6738.00). Conclusion – The administration of more vials of antivenin is potentially associated with negative outcome; however, a causal relationship has not been established. Controlled, prospective studies are needed to optimize antivenin administration.     

Case–control study of Staphylococcus lugdunensis infection isolates from small companion animals

Background – Coagulase‐negative Staphylococcus lugdunensis has recently been shown to cause invasive infections of people, which are similar in pathogenic effect to those caused by Staphylococcus aureus. Little is known about the pathogenicity of S. lugdunensis in companion animals. Objectives – To compare potential risk factors for infection, body sites affected, and whether cases and controls had been treated with antimicrobial drugs based upon susceptibility test results. Animals – Thirty‐three cases of S. lugdunensis infection (25 dogs, six cats and two small mammals) were identified between January 2003 and August 2011. Two Staphylococcus pseudintermedius controls, which were identified by the microbiology laboratory immediately before and after each S. lugdunensis case, were host‐species matched to each case. Methods – A retrospective case–control analysis. Results – During the period evaluated, the prevalence of S. lugdunensis infection was 1.3 cases per 10,000 hospital admissions for dogs and 0.95 cases per 10,000 admissions for cats (P = 0.453). In univariate analyses, S. pseudintermedius isolation was significantly associated with skin infections (P < 0.0001), while S. lugdunensis isolation was associated with the respiratory tract (P = 0.03) and other deep tissues (P = 0.005). Cases were less likely than controls to have been treated based upon susceptibility test results (P = 0.02). A conditional logistic regression analysis showed isolation of S. lugdunensis to be associated with recent (≤ 30 days) steroid administration (odds ratio, 17.72; 95% confidence interval, 2.35–132.82; P = 0.005); and in‐patient status (odds ratio, 9.67; 95% confidence interval, 2.18–42.88; P = 0.003). Conclusions – These results suggest that S. lugdunensis may cause invasive infections in companion animals, which should be treated with antimicrobials based upon susceptibility tests when available.     

Peripheral Nucleated Red Blood Cells as a Prognostic Indicator in Heatstroke in Dogs

Background: Heatstroke in dogs is often fatal and is associated with a high prevalence of secondary complications. Peripheral nucleated red blood cells (NRBC) occur in dogs with heatstroke, but their association with complications and the outcome is unclear.
Hypothesis: Peripheral NRBC are common in dogs with heatstroke and have prognostic significance.
Animals: Forty client-owned dogs with naturally occurring heatstroke.
Methods: Prospective, observational study. Dogs were followed from presentation to discharge or death. Serum biochemistry and coagulation tests were performed at presentation. CBC and evaluation of peripheral blood smears were performed at presentation and every 12 hours. The relative and the absolute NRBC numbers were calculated.
Results: Presence of NRBC was observed in 36/40 (90%) of the dogs at presentation. Median relative and absolute NRBC were 24 cells/100 leukocytes (range 0–124) and 1.48 × 10³/μL (range 0.0–19.6 × 10³/μL), respectively. Both were significantly higher in nonsurvivors (22) versus survivors (18) and in dogs with secondary renal failure and DIC versus those without these complications. Receiver operator curve analysis of relative NRBC at presentation as a predictor of death had an area under curve of 0.92. A cut-off point of 18 NRBC/100 leukocytes corresponded to a sensitivity and specificity of 91 and 88% for death.
Conclusions and Clinical Importance: Relative and absolute numbers of peripheral NRBC are clinically useful, correlate with the secondary complications, and are sensitive and specific markers of death in dogs with heatstroke, although they should never be used as a sole prognostic indicator nor should they replace clinical assessment.     

Multidrug-resistant E. coli and enterobacter extraintestinal infection in 37 dogs

BACKGROUND: Extraintestinal infections caused by multidrug-resistant (MDR) Escherichia coli and Enterobacter are becoming more common in veterinary medicine. OBJECTIVE: To generate hypotheses for risk factors for dogs acquiring extraintestinal infection caused by MDR E. coli and Enterobacter, describe antimicrobial resistance profiles and analyze treatment and clinical outcomes. ANIMALS: Thirty-seven dogs diagnosed with extraintestinal infection caused by MDR E. coli and Enterobacter spp. between October 1999 and June 2006. METHODS: Retrospective case series assembled from hospital records data, including clinical history before 1st MDR isolation and treatment outcome. Identity and antimicrobial susceptibility profiles were confirmed by standard microbiological techniques for 57 isolates. RESULTS: Most dogs had an underlying disease condition (97%), received prior antimicrobial treatment (87%), were hospitalized for >or =3 days (82%), and had a surgical intervention (57%). The urinary tract was the most common infection site (62%), and urinary catheterization, bladder stasis, or both were common among dogs (24%). Some dogs were treated with high doses of co-amoxyclavulanate (n = 14) and subsequently recovered even though the isolates showed in vitro resistance to this antimicrobial. Other dogs were successfully treated with chloramphenicol (n = 11) and imipenem (n = 2). CONCLUSION AND CLINICAL IMPORTANCE: Predisposing disease condition, any prior antimicrobial use rather than a specific class of antimicrobial, duration of hospitalization, and type of surgical procedure might be risk factors for acquiring MDR extraintestinal infections. Whereas culture and sensitivity results can indicate use of last-resort antimicrobials such as imipenem for MDR infections, some affected dogs can recover after administration of high doses of co-amoxyclavulanate.     

Effect of parvoviral enteritis on plasma citrulline concentration in dogs

Background: Plasma citrulline concentration is a reliable marker of global enterocyte mass in humans and is markedly decreased in diffuse small intestinal diseases. However, the relationship between acute intestinal damage and plasma citrulline concentration in dogs has never been documented. Hypothesis: That dogs with parvoviral enteritis have a lower plasma citrulline concentration than healthy dogs and that plasma citrulline concentration is a predictor of death in puppies with parvoviral enteritis. Animals: Sixty‐one dogs with spontaneous parvoviral enteritis and 14 healthy age‐matched control dogs. Methods: Observational cohort study. Plasma citrulline concentration was measured by liquid chromatography and tandem mass spectrometry in blood samples collected at admission and each day until death or discharge from the hospital. Parvovirus enteritis was confirmed by electron microscopy on a fecal sample. Results: Median (interquartile range) plasma citrulline concentrations at admission were 2.8 μmol/L (range: 0.3, 49.0; P < .001 versus controls) in survivors (n = 49), 2.1 μmol/L (range: 0.5, 6.4, P < .001 versus controls) in nonsurvivors (n = 12) and 38.6 μmol/L (range: 11.4, 96.1) in controls (n = 14), respectively. There was no significant difference in plasma citrulline concentration between survivors and nonsurvivors within the parvovirus‐infected puppies, and plasma citrulline concentration was not significantly associated with outcome in parvoviral enteritis. There were no significant changes in plasma citrulline concentration over the 8‐day follow‐up period. Conclusion and Clinical Importance: Parvovirus enteritis is associated with a severe decrease in plasma citrulline concentration that does not appear to have any significant prognostic value.     

Increased Lactate Concentrations in III and Injured Dogs

Venous blood lactate concentrations were measured on 109 ill dogs and 20 clinically normal dogs. Ill dogs were grouped into survivor and nonsurvivor groups, and categorized based on their primary problem. Ninety-five percent of ill dogs had lactate concentrations higher than clinically normal dogs and published normal values. Seventy-six percent of ill dogs with increased lactate concentrations survived to be discharged. Lactate concentrations were significantly higher in nonsurvivors than in survivors and clinically normal dogs. Lactate concentrations in dogs with major trauma and intoxications, and with cardiopulmonary, gastrointestinal, and neurologic problems were significantly higher than in clinically normal dogs and dogs with other problems. (Vet Emerg & Crit Care, 1998; 8: 117–127)     

Skin lipid profiling in normal and seborrhoeic shih tzu dogs

Background – Seborrhoea is a clinical condition resulting in excessive lipid and/or scale on the skin and is a common and important skin disease of dogs. However, there is little information on the skin surface lipid composition of dogs with seborrhoea. Hypothesis/Objectives – To compare skin surface lipid profiles in normal and seborrhoeic shih tzu dogs. Methods – Fourteen client‐owned dogs (seven seborrhoeic and seven normal) were investigated. Lipids in sebaceous glands (SGs) were extracted from homogenized tissues of SG hyperplasia. Surface lipid was collected by tape stripping [stratum corneum (SC)‐enriched fraction] and acetone‐wetted cotton swab (acetone‐extracted fraction). Lipids in SGs, SC‐enriched fractions and acetone‐extracted fractions were evaluated by high‐performance thin‐layer chromatography. Results – Lipids in SGs mainly consisted of cholesterol esters, wax esters and triglycerides, whereas lipids in the SC‐enriched fraction mainly consisted of ceramides. The acetone‐extracted fraction contained a mixture of lipid classes recognized in SG‐ and SC‐enriched fractions. In seborrhoeic dogs, concentrations of wax esters and triglycerides in the acetone‐extracted fraction were significantly higher than in control dogs (P = 0.0285). Amounts of total ceramides (in micrograms) per milligram of SC were not significantly different between the two groups (P = 0.5204). Interestingly, two unknown ceramide fractions, which accounted for 20% of the total ceramides, were recognized exclusively in seborrhoeic dogs. Conclusions and clinical importance – These results provide evidence that the skin surface lipid profiles are altered in shih tzu dogs with seborrhoea.     

A retrospective review of acute myeloid leukaemia in 35 dogs diagnosed by a combination of morphologic findings,flow cytometric immunophenotyping and cytochemical staining results (2007‐2015)

Acute myeloid leukaemia (AML) is an uncommon, rapidly progressive neoplasm in dogs. The aim of this retrospective study was to characterize the clinical presentation, haematologic findings, diagnostic imaging results, treatment and survival time of a contemporary cohort of dogs with AML. Diagnosis was based on >20% blasts in bone marrow or blood identified as myeloid based on morphologic findings, flow cytometric immunophenotyping and cytochemical staining. Medical records of 35 dogs diagnosed with AML from 2007 to 2015 were included. Most dogs presented with inappetence (66%) and lethargy (57%) and physical examination findings of peripheral lymphadenopathy (74%) and tachypnea (62%). Common haematologic findings were quantifiable circulating blasts (85%; median blast count 35 700/μL; range: 300‐276 500/μL), anaemia (median haematocrit 34%; range: 11%‐52%) and thrombocytopenia (median 57 000/μL; range: 9000‐252 000/μL). Bicytopenia and pancytopenia were each found in 44% of dogs. Follow‐up information was available for 34 dogs. The overall median survival time from diagnosis was 19 days (range: 1‐121 days). Clinical progression in some dogs was not as rapid as previously reported. Haematologic responses to various chemotherapeutics were documented in 3 dogs, with associated survival times of 62, 103 and 121 days. Dogs treated with prednisone or a combination of chemotherapy and prednisone had improved survival compared to dogs that received symptomatic care only (P < .0001). Our results show canine AML has an overlapping clinical presentation with lymphoma. The prognosis for canine AML remains extremely guarded. Further studies are needed to optimize therapeutic regimens for dogs with AML.     

Development of a clinical severity index for dogs with acute pancreatitis

Objective-To establish a clinical severity index that correlates severity of body system abnormalities with outcome in dogs with acute pancreatitis (AP) and determine the usefulness of serum C-reactive protein (C-RP) concentration as an objective measure of AP severity. Design-Retrospective cohort study. Animals-61 client-owned dogs with ultrasonographically or histologically confirmed AP. Procedures-Medical records of AP-affected dogs were reviewed, and signalment, physical examination findings, clinicopathologic data, and outcome (death or discharge from the hospital) were evaluated. The correlation of specific abnormalities in endocrine, hepatic, renal, hematopoietic, cardiovascular, and respiratory systems; local pancreatic complications; and intestinal integrity were evaluated, and a clinical severity index was developed for AP in dogs. The severity index score was compared with outcome and, for 12 dogs, with serum C-RP concentration. Results-The clinical severity index had a good correlation with outcome and interval from hospital admission until end point (days until outcome), but there was no difference in days until outcome between survivors and nonsurvivors. All 12 dogs evaluated had high serum C-RP concentration, but this variable was not related to outcome; however, within a 2-day period after onset of clinical signs, serum C-RP concentration in survivors and nonsurvivors differed significantly. Conclusions and Clinical Relevance-Among AP-affected dogs, the clinical severity index may be useful for treatment comparisons and prediction of intensive management requirements. Serum C-RP concentration was best related to AP severity within a 2-day period after onset of clinical signs, but daily measurement may be more useful for monitoring progress.     

Hemilaminectomy and vertebral stabilisation for the treatment of thoracolumbar disc protrusion in 28 dogs

Objectives : To evaluate the results of hemilaminectomy and vertebral stabilisation (+/? annulectomy) for the treatment of thoracolumbar disc protrusion. Methods : The medical records of dogs with thoracolumbar annular protrusions treated by hemilaminectomy and vertebral stabilisation were reviewed. Neurological function was assessed 24 hours following surgery. Long‐term follow‐up was by clinical examination or telephone questionnaire. Results : Twenty‐eight dogs fulfilled the criteria. Age ranged from 4 to 12·5 years (median 8 years, mean 7·7 years), bodyweight from 5·1 to 51·5 kg (median 28 kg, mean 27·1 kg), and duration of neurological signs before presentation from 48 hours to 104 weeks (median 5 weeks, mean 9·3 weeks). At presentation 22 dogs were ambulatory and six were non‐ambulatory. Myelography and/or magnetic resonance imaging (MRI) identified 31 thoracolumbar protrusions causing spinal cord compression. Unilateral hemilaminectomy was performed in 27 dogs and bilateral hemilaminectomy in one dog. Partial annulectomy was performed in 24 of 31 protrusions. Stabilisation was performed using vertebral body bone plates in 26 dogs and vertebral body screws and bone cement in two dogs. Internal vertebral venous plexus haemorrhage was recorded in nine dogs. A screw was inadvertently placed into an intervertebral disc in two dogs. Neurological examination 24 hours postoperatively revealed deterioration in pelvic limb motor function in 17 dogs. One dog was euthanatised at the owner’s request 6 days after surgery. Long‐term evaluation of 24 cases was performed 3 to 52 months following surgery (median 21 months, mean 23·9 months). Six dogs had improved from their preoperative status and one had deteriorated as assessed by the authors. Fifteen dogs had improved from their preoperative status and two were unchanged as assessed by owners. Clinical Significance : Hemilaminectomy and vertebral stabilisation are an effective treatment for chronic spinal cord compression due to thoracolumbar annular protrusion in dogs. A temporary deterioration in neurological function is not uncommon following surgery. Internal vertebral plexus haemorrhage and inappropriate vertebral body screw placement are potential complications.     

High‐mobility group box 1 as a surrogate prognostic marker in dogs with systemic inflammatory response syndrome

Objective – To evaluate various surrogate markers associated with the inflammatory and counter‐inflammatory responses with respect to mortality in dogs with systemic inflammatory response syndrome (SIRS). Design – Prospective observational study. Setting – Veterinary Teaching Hospital. Animals – Twenty‐eight dogs with naturally occurring diseases and SIRS from January 2007 to May 2009. Interventions – Upon admission to the veterinary hospital, history and baseline data from the physical examination, including parameters previously defined for meeting SIRS criteria, were documented. Heparinized blood samples were collected and plasma cytokines interleukin‐6 (IL‐6), IL‐10, and high‐mobility group box 1 (HMGB1) were measured by sandwich ELISA. Measurements and Main Results – In nonsurvivors, median plasma HMGB1 concentrations (0.718 μg/L, interquartile range [IQR]; 0.300–1.626 μg/L) and the ratio of HMGB1 to IL‐10 (2.236, IQR; 0.972–5.367) were significantly increased as compared with those found in survivors (0.300 μg/L, IQR; 0.300–0.312 μg/L for HMGB1; 1.017, IQR; 0.862–1.126 for the ratio of HMGB1 to IL‐10, P=0.007 and 0.024, respectively). Plasma IL‐6, IL‐10, and the ratio of IL‐6 to IL‐10 were not significantly different between groups. Among the parameters studied, HMGB1 and the ratio of HMGB1 to IL‐10 performed the best in discriminating outcome in dogs with SIRS according to receiver operator characteristic curve analysis. Conclusions – Increases in plasma HMGB1 concentration and the ratio of HMGB1 to IL‐10 may predict poorer outcomes in dogs with SIRS. The approach described may lead to reliable prognostic biomarkers and new therapeutic concepts in the study of SIRS in dogs.     

Association of hyponatremia and hyperglycemia with outcome in dogs with congestive heart failure

Objective: To evaluate plasma sodium and glucose concentrations in dogs with congestive heart failure (CHF) prior to treatment and evaluate the differences between survivors and non‐survivors. Design: Retrospective study. Animals: Fifty‐nine dogs with CHF prior to receiving cardiac medication. Interventions: None. Measurements and main results: The mean plasma sodium concentration in dogs with CHF was below the reference range (144–156 mmol/L) and significantly lower (P=0.009) in non‐survivors (141±6 mmol/L) compared with survivors (147±4 mmol/L). The mean plasma glucose concentration was above the reference range (76–117 mg/dL) and significantly higher (P=0.004) in non‐survivors (128±52 mg/dL) compared with survivors (100±13 mg/dL). Forty‐four percent of non‐survivors had concurrent low plasma sodium and high plasma glucose concentrations, whereas no survivors had both abnormalities (P<0.0001). Conclusions: Lower plasma sodium and higher plasma glucose are associated with a worse outcome in dogs with CHF.     

Evaluation of latex agglutination kits for detection of fibrin(ogen) degradation products and D-dimer in healthy horses and horses with severe colic

Background: Fibrin(ogen) degradation products (FDPs) and D‐dimer are sensitive indicators of excessive fibrinolysis due to disseminated intravascular coagulation (DIC) in dogs. To the authors' knowledge, latex‐agglutination–based plasma FDP and D‐dimer assays have not been validated for use in horses. Objectives: To determine: 1) sensitivity and specificity of latex‐agglutination serum and plasma FDP and D‐dimer assays for diagnosis of DIC; and 2) their prognostic value in horses with severe colic. Methods: At hospital admission and 24 hours later, blood was collected from 30 healthy horses and 20 horses with severe colic. Horses fulfilling predefined laboratory criteria of DIC were enrolled, and their data were subcategorized by survival for analysis. Platelet counts were determined and coagulation panel testing was performed. Serum and plasma FDP concentrations were measured using separate latex agglutination kits. Plasma D‐dimer concentration was measured using 3 latex agglutination kits and a card immunofiltration test. Test sensitivity and specificity results were determined for healthy horses and those with colic. Median test values were compared between colic survivors and nonsurvivors to evaluate the prognostic usefulness of all tests. Results: Performance characteristics varied among assays and kit suppliers. The FDP assays had low sensitivity (<40%), whereas the most accurate D‐dimer kit had 50% sensitivity and 97% specificity. High D‐dimer concentration was the third most common hemostatic abnormality in horses with colic. Median antithrombin (AT) activity was significantly lower and activated partial thromboplastin time (aPTT) was significantly longer in nonsurvivors than survivors. Conclusions: Commercial latex‐agglutination D‐dimer assays might prove useful as adjunctive tests for the diagnosis of DIC in horses with severe colic; however FDP assays are invalid for this purpose. Low AT activity and prolonged aPTT at admission are associated with a poor prognosis in this patient population.     

Use of serum concentrations of interleukin-18 and monocyte chemoattractant protein-1 as prognostic indicators in primary immune-mediated hemolytic anemia in dogs

Background: The cytokine response in immune‐mediated hemolytic anemia (IMHA) is poorly characterized and correlation with outcome is unknown. Hypothesis/Objectives: To determine if cytokine activity is correlated with outcome in dogs with IMHA. Animals: Twenty dogs with primary IMHA and 6 control dogs. Methods: Prospective study on dogs with IMHA with blood sampling at admission. Serum activity of interleukin‐2 (IL‐2), IL‐4, IL‐6, IL‐7, IL‐8, IL‐10, IL‐15, IL‐18, monocyte chemoattractant protein‐1 (MCP‐1), granulocyte‐macrophage colony stimulating factor (GM‐CSF), interferon‐inducible protein‐10, interferon‐gamma, and keratinocyte chemoattractant (KC) was assessed. Results: Thirty‐day case fatality rate was 25% (5/20 dogs). Increased concentrations (median [range]) of IL‐2 (45.5 ng/L [0;830] versus 0 ng/L [0;46.8]), IL‐10 (8.2 ng/L [0;60.6] versus 0 ng/L [0;88.2]), KC (1.7 μg/L [0.3;4.7] versus 0.5 μg/L [0.2;1.1]), and MCP‐1 (162 ng/L [97.6;438] versus 124 ng/L [90.2;168]) were observed in dogs with IMHA compared with controls. The cytokine profile was indicative of a mixture of pro‐ and anti‐inflammatory cytokines of various cellular origins. Cytokines/chemokines strongly associated with macrophage/monocyte activation and recruitment were significantly increased in nonsurvivors compared with survivors; IL‐15 (179 ng/L [48.0;570] versus 21.3 ng/L [0;193]), IL‐18 (199 ng/L [58.7;915] versus 37.4 ng/L [0;128]), GM‐CSF (134 ng/L [70.0;863] versus 57.6 ng/L [0;164]), and MCP‐1 (219 ng/L [135;438] versus 159 ng/L [97.6;274]), respectively. Logistic regression suggested increased IL‐18 and MCP‐1 concentrations were independently associated with mortality in this population (P<.05, Wald's type 3). Conclusions and Clinical Importance: A mixed cytokine response is present in dogs with IMHA and mediators of macrophage activation and recruitment might serve as prognostic indicators.     

Histiocytic sarcomas in flat-coated retrievers: a summary of 37 cases (November 1998–March 2005)

Thirty‐seven cases of histiocytic‐like sarcomas (HLSs) in flat‐coated retriever dogs were evaluated retrospectively. This tumour accounted for 36% of the malignant tumours seen in this breed during the study period. The median age at presentation was 8.2 years. Thirty‐four dogs presented with a swelling or mass in a muscle group or surrounding a joint. The remaining three presented for rib (1), cutaneous (1) or primary splenic origin (1). A high rate of metastasis to local lymph nodes (45%), thorax (20%) and abdominal organs (20% confirmed) was seen. Overall metastastic rate by the time of death was 70%. The median survival for all dogs was 123 days. The most significant prognostic indicator was presence of distant metastasis at the time of diagnosis with median survival of 68 or 200 days, with or without metastasis, respectively. Chemotherapy and radiation therapy significantly improved survival. Dogs given chemotherapy survived a median of 185 versus 34 days for dogs that were not (P = 0.0008). Dogs treated with radiation survived a median of 182 versus 60 days for those that were not (P = 0.0282). Dogs receiving only palliative therapy survived a median of 17 versus 167 days in dogs receiving any kind of radiation, chemotherapy, surgery or combinations. A set protocol of radiation and CCNU (RTCCNU) induced minimal toxicity and provided a median survival of 208 versus 68 days for all other dogs. While this tumour carries a poor long‐term prognosis in flat‐coated retrievers, it is reasonable to treat these dogs for palliation of signs and extension of life.     

Evaluation of acute congestive heart failure in dogs and cats: 145 cases (2007–2008)

Objective – To characterize the clinical presentation, management, and in‐hospital outcomes of dogs and cats diagnosed with acute congestive heart failure (CHF). Design – Retrospective study of animals seen between January 2007 and May 2008. Setting – Emergency service at a university teaching hospital. Animals – Ninety dogs and 55 cats with CHF. Measurements and Main Results – Patient characteristics, including age, clinical signs, clinicopathologic abnormalities, diagnostic testing, and outcome were recorded. Forty‐eight of the animals already were receiving cardiac medications at the time of presentation. The most common diseases represented were chronic valvular disease and cardiomyopathies. Cats had significantly lower median body temperature at admission compared with dogs (P<0.001). The most common abnormalities were elevated lactate (64%), elevated BUN (52%), hypochloremia (31%), hyperglycemia (27%), and elevated liver enzymes (26%). Many of these became even more prevalent during hospitalization. One hundred and sixteen animals were discharged from the hospital, for a survival rate of 80%. There was no survival difference between dogs and cats (P=0.39). Dogs that developed hypokalemia during hospital stay (P=0.04) were more likely to survive compared with those without hypokalemia and initial body temperature was lower for those cats that did not survive (P=0.02). Of those that did not survive, the majority were euthanized (n=25), while 4 dogs died. Conclusions – Dogs and cats presented to the emergency service with CHF had a high survival rate. In cats, initial body temperature was lower for those cats that did not survive. Although clinicopathologic abnormalities were common in both species, only dogs with hypokalemia had improved survival to hospital discharge.