Development of a clinical severity index for dogs with acute pancreatitis

Mansfield, CS; James, Fleur; Robertson, Ian

doi:10.2460/javma.233.6.936

Cited by 83 publications

(140 citation statements)

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“…1 Another tool that has been used to evaluate severity of disease in dogs with a variety of disorders is C-reactive protein (CRP). [2][3][4][5] Increases in CRP concentration occur and resolve in direct proportion to the degree of tissue inflammation but are not specific for individual disease processes. 2 One recent study found no difference in CRP concentrations for critically ill dogs admitted to an intensive care unit that survived compared with nonsurvivors.…”

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confidence: 99%

Associations among Albuminuria, C‐Reactive Protein Concentrations, Survival Predictor Index Scores, and Survival in 78 Critically Ill Dogs

Whittemore

Marcum

Mawby

et al. 2011

Veterinary Internal Medicne

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Background: Microalbuminuria and C-reactive protein (CRP) are predictors of morbidity and survival in critically ill human patients.Hypothesis/Objectives: To evaluate results of microalbuminuria assays (untimed single-sample urine albumin concentration [U-ALB] and the urine albumin : creatinine ratio [UACR]), serum CRP, and survival predictor index (SPI2) scores as predictors of survival in critically ill dogs.Animals: Seventy-eight dogs admitted to intensive care units at University of Tennessee (UT) and Colorado State University (CSU).Methods: Prospective observational study. Critically ill dogs were eligible for enrollment, unless euthanized because of financial constraints. Samples were collected within 3 hours of admission. Spearman's rank-correlation coefficients were determined for U-ALB, UACR, CRP, and SPI2. U-ALB, UACR, CRP, and SPI2 were assessed for associations with 7-and 30-day survival by Mann-Whitney U-tests and receiver operating characteristic (ROC) curves. P-values o .0125 were considered significant.Results: UT (n 5 49) and CSU (n 5 29) patients did not differ significantly. Forty percent (31/78) of dogs died. SPI2 was inversely correlated with U-ALB (r s 5 À0.39, P o .001) and UACR (r s 5 À0.41, P o .001). CRP was not correlated with SPI2 (P 5 .019), U-ALB (P 4 .1), or UACR (P 4 .1). U-ALB and UACR had very high correlation (r s 5 0.95, P o .001). SPI2, U-ALB, and UACR differed significantly for survivors and nonsurvivors. SPI2, U-ALB, and UACR had areas under the ROC curve (AUC) from 0.68 to 0.74 for survival prediction.Conclusions and Clinical Importance: Albuminuria and SPI2, but not CRP, are associated with survival in critically ill dogs. Suboptimal AUCs limit the value of microalbuminuria testing for clinical risk assessment. Additional studies are necessary to determine the usefulness of microalbuminuria testing in patient risk stratification for prospective research.

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confidence: 99%

Associations among Albuminuria, C‐Reactive Protein Concentrations, Survival Predictor Index Scores, and Survival in 78 Critically Ill Dogs

Whittemore

Marcum

Mawby

et al. 2011

Veterinary Internal Medicne

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“…One hypothesis for the lack of association between CRP elevations and pancreatitis is the timing of CRP measurement with respect to stage and onset of disease. 12,24 Serum CRP concentrations are thought to relate to the extent of tissue damage and/ or inflammation; 18 however, only 1 dog had a pancreatic biopsy to assess tissue damage/inflammation in the current study. Although CRP response can vary dramatically in different individuals with the same disease process at presentation, evaluating sequential measurements and degree of decrease in serum CRP concentrations may provide more useful information than a single CRP value.…”

Section: Discussionmentioning

confidence: 89%

“…In the current study, although serum CRP concentration was elevated on presentation in 21 out of 32 dogs, a single CRP determination did not facilitate prediction of outcome, a finding that has been previously reported in dogs with various inflammatory conditions. 3,7,8,12,13,21 Only 3 out of the 28 dogs that had serial CRP concentrations died. Figure 1 suggests that average initial CRP concentrations are predicative of survival.…”

Section: Discussionmentioning

confidence: 99%

“…4 The measurement of individual and combinations of APPs has been studied in human and veterinary medicine as a means of evaluating treatment efficacy and, in some cases, predicting future outcome. 8,12,16 Serial concentrations of serum CRP are used to predict the development of necrosis, infection, or both, and assess treatment efficacy in humans with acute pancreatitis. 2,14,22,24 As a major APP in dogs, serum CRP concentration can increase 10-fold to 100-fold in a variety of conditions, including immune-mediated hemolytic anemia, 7,16 pyometra, 6,27 infections, 12,27 acute pancreatitis, 8,12 and neoplasia.…”

Section: Introductionmentioning

confidence: 99%

“…8,12,16 Serial concentrations of serum CRP are used to predict the development of necrosis, infection, or both, and assess treatment efficacy in humans with acute pancreatitis. 2,14,22,24 As a major APP in dogs, serum CRP concentration can increase 10-fold to 100-fold in a variety of conditions, including immune-mediated hemolytic anemia, 7,16 pyometra, 6,27 infections, 12,27 acute pancreatitis, 8,12 and neoplasia. 15,17,20,23,25,26 Previous studies in dogs have demonstrated that decreasing serum CRP concentration following appropriate therapy is associated with clinical improvement.…”

Section: Introductionmentioning

confidence: 99%

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C-Reactive Protein as a Prognostic Indicator in Dogs with Acute Abdomen Syndrome

et al. 2010

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Abstract. The objective of the present study was to measure serum C-reactive protein (CRP) concentrations in 32 dogs with acute abdomen syndrome at presentation and after 48-72 hr. Data were evaluated to determine if there was an association between CRP concentration and outcome, and if CRP concentration correlated with the white blood cell (WBC) count at both time points. An immunoturbidimetric assay for human CRP, previously validated for use in dogs, was used for serum CRP analysis. Increased serum CRP concentrations were found in 21 dogs at presentation. Fifteen of these dogs had declining serum CRP concentrations by 48-72 hr, but 3 of the 15 dogs were later euthanized. Serum CRP concentrations increased by 48-72 hr in 4 dogs. Of the 32 dogs, 4 were dead or were euthanized prior to the 48-72 hr time point. No significant difference between initial CRP concentration and outcome was found (P 5 0.054). Initial and 48-72 hr CRP values taken together were significantly different between outcome groups (P , 0.001). Serum CRP concentrations that were elevated at both time points were associated with a poor prognosis. No correlation was found between CRP concentrations and WBC counts at presentation (P 5 0.83); however, a significant correlation was noted at 48-72 hr (P 5 0.03). Evaluation of sequential CRP concentrations in dogs with acute abdomen syndrome may be helpful in assessing clinical response to treatment and predicting outcome. Also, serum CRP may be better in detecting tissue injury and/or inflammation at presentation than WBC counts in select cases.

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Pancreatitis

Tinson

Boller

2018

Textbook of Small Animal Emergency Medicine

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Development of a clinical severity index for dogs with acute pancreatitis

Cited by 83 publications

References 41 publications

Associations among Albuminuria, C‐Reactive Protein Concentrations, Survival Predictor Index Scores, and Survival in 78 Critically Ill Dogs

Associations among Albuminuria, C‐Reactive Protein Concentrations, Survival Predictor Index Scores, and Survival in 78 Critically Ill Dogs

C-Reactive Protein as a Prognostic Indicator in Dogs with Acute Abdomen Syndrome

Pancreatitis

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