Evaluation of C‐reactive protein and its kinetics as a prognostic indicator in canine leptospirosis

Abstract

Objective To evaluate C‐reactive protein at presentation and during hospitalisation in dogs with acute kidney injury resulting from leptospirosis to compare C‐reactive protein at presentation in dogs with acute kidney injury of different aetiology and to study its correlation with markers of inflammation, azotaemia and survival. Materials and Methods Prospective observational study of 41 dogs with acute kidney injury secondary to leptospirosis and 15 control dogs with acute kidney injury of different aetiology. C‐reactive protein was measured at presentation in both groups and daily for 7 days in a subgroup of 28 dogs with leptospirosis. The associations of C‐reactive protein with neutrophil count, albumin, urea, creatinine and survival were analysed. Results C‐reactive protein was increased at presentation in all dogs with leptospirosis but was not significantly different from dogs with acute kidney injury of different cause. It was associated with markers of inflammation (neutrophil count, albumin) but not with azotaemia (creatinine, urea). It decreased gradually from presentation to day 4, with significantly lower concentrations in survivors than non‐survivors. Initial C‐reactive protein was only weakly associated with outcome, but its average concentration from presentation to day 2 was more strongly associated. Absolute and relative changes in C‐reactive protein during hospitalisation and creatinine at presentation were not associated with survival. Clinical Significance Serial assessment of C‐reactive protein may improve outcome prediction in dogs with leptospirosis compared with a single measurement at presentation or with markers of renal function.

Updated ACVIM consensus statement on leptospirosis in dogs

“…Mild to moderate hypoalbuminemia frequently is observed in dogs with leptospirosis (18%‐88%). C‐reactive protein has been moderately increased in all dogs with Leptospira ‐induced AKI, 72,77 but this was not different from dogs with AKI from other causes 72 . Electrolyte abnormalities may relate to gastrointestinal or kidney dysfunction and may be aggravated by direct inhibition of the tubular Na + ‐K + ‐ATPase by leptospiral endotoxin 81 .…”

“…The most common CBC findings include neutrophilia (27%‐94%), increased band neutrophils (3%‐81%), lymphopenia (2%‐29%), monocytosis (29%‐68%), thrombocytopenia (14%‐73%), and mild to moderate, non‐regenerative anemia (18%‐92%) 48,64‐79 . Uncommonly, severe anemia occurs, which may follow gastrointestinal or pulmonary hemorrhage 80 .…”

“…Leptospiral pulmonary hemorrhage syndrome has been associated with mortality of up to 70% 48,49 although mild forms exist that can resolve with antimicrobial treatment. Normalization of C‐reactive protein with treatment parallels a favorable clinical course of the disease 72 . A clinical scoring system has been developed and validated for dogs with AKI managed with EKST; higher scores are associated with poorer outcomes 138,139 .…”

“…Normalization of C-reactive protein with treatment parallels a favorable clinical course of the disease. 72 A clinical scoring system has been developed and validated for dogs with AKI managed with EKST; higher scores are associated with poorer outcomes. 138,139 For dogs treated using EKST (and not for other dogs with leptospirosis), this model could be used cautiously as a tool for therapeutic decision making.…”

Evaluation of Host Constitutive and Ex Vivo Coccidioidal Antigen-Stimulated Immune Response in Dogs with Naturally Acquired Coccidioidomycosis

“…C-reactive protein is a positive acute phase protein that is produced as a reaction to various types of systemic inflammation such as infectious, neoplastic, non-infectious inflammatory, and immune-mediated disorders [ 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ]. It has been used as a viable biomarker to guide clinical decisions regarding several disorders in dogs, such as prognosis, remission, relapse, and extent of infection [ 26 , 27 , 30 , 31 , 32 , 33 , 34 ]. Evidence suggests that CRP is not only a marker of inflammation but has an active immunologic role in the host response to infections [ 35 ].…”