Development and validation of a novel clinical scoring system for short‐term prediction of death in dogs with acute pancreatitis

Abstract

Background Acute pancreatitis (AP) is associated with a high death rate in dogs, but accurate predictors of early death are still lacking. Objectives To develop a scoring system for prediction of short‐term case fatality in dogs with AP. Animals One hundred sixty‐nine dogs with AP including 138 dogs in the training cohort and 31 dogs in the validation cohort. Methods Multicenter, retrospective cohort study. Survival analysis was used to assess the associations with short‐term death (within 30 days after admission). Independent predictors of death were identified by a stepwise selection method and used for the score calculation. Results Death rate within 30 days after admission was 33% in the training cohort. Four independent risk factors for short‐term death were identified in the training cohort: presence of systemic inflammatory response syndrome, coagulation disorders, increased creatinine and ionized hypocalcemia. Canine Acute Pancreatitis Severity (CAPS) score was developed to predict short‐term death, integrating these 4 factors in a weighted way. A simplified version of CAPS score (sCAPS) including respiratory rate instead of SIRS was also assessed. The area under the receiver‐operating characteristic curve (AUC) of CAPS and sCAPS scores was 0.92 in the training cohort with an optimal cutoff of 11 (sensitivity, 89%; specificity, 90%) and 6 (sensitivity, 96%; specificity, 77%), respectively. CAPS and sCAPS score were validated in the validation cohort with respective AUC of 0.91 and 0.96. Conclusions and Clinical Importance We propose 2 scoring systems that allow early and accurate prediction of short‐term death in dogs with AP.

Association between abdominal ultrasound findings, the specific canine pancreatic lipase assay, clinical severity indices, and clinical diagnosis in dogs with pancreatitis

“…No other variables were excluded. The second clinical severity index evaluated was the CAPS score, which was recently validated in dogs with acute pancreatitis . Again, this score system was applied with minor modification, in that total calcium was utilized if an iCa was not performed.…”

“…In recent years, a number of clinical severity indices have been developed and validated for dogs admitted to intensive care units and in dogs with acute pancreatitis. Two such clinical severity indices include the acute patient physiologic and laboratory evaluation (APPLE) score and the canine acute pancreatitis severity (CAPS) score . Both the APPLE and CAPS scores were retrospectively calculated for each dog based on data collected at admission, with minor modification due to typical practices at the author's institution.…”

“…Two such clinical severity indices include the acute patient physiologic and laboratory evaluation (APPLE) score and the canine acute pancreatitis severity (CAPS) score. 18,19 Both the APPLE and CAPS scores were retrospectively calculated for each dog based on data collected at admission, with minor modification due to typical practices at the author's institution. For the modified CAPS, total calcium was utilized in place of ionized calcium (iCa) when the iCa was unavailable for review.…”

“…It has also been suggested that repeat AUS examinations can be used to monitor response to treatment, but in the absence of scientific study this remains controversial . Clinical severity indices have been validated but it is currently unknown if ultrasonographic assessment of the severity of pancreatitis mirrors these indices . Therefore, the value of repeat AUS for monitoring of routine pancreatitis cases is unknown.…”

“…12 Clinical severity indices have been validated but it is currently unknown if ultrasonographic assessment of the severity of pancreatitis mirrors these indices. 18,19 Therefore, the value of repeat AUS for monitoring of routine pancreatitis cases is unknown.…”