Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication

Abstract

Objectives The current study was designed to evaluate the prevalence and prognostic significance of multi-organ dysfunction syndrome (MODS) in cats with sepsis. Methods Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman's rank correlation coefficient. Significance was set at P <0.05. Results A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores. Conclusions and relevance MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.

Classification of Septic Shock Phenotypes Based on the Presence of Hypotension and Hyperlactatemia in Cats

“…Variables that were significantly different between survivors and non-survivors were entered into a univariate logistic regression analysis. There were positive associations between odds of mortality and body temperature, lymphocyte count, APPLE fast score, low BCS ( 1 – 3 ) and MODS occurrence. MODS and lymphocyte count were the only variables retained in the multivariate model (OR = 4.3, CI 1.5–12.4; OR = 0.99, CI 0.99–1.0, respectively).…”

“…The 5-variables feline Acute Patient Physiologic and Laboratory Evaluation fast (APPLE fast ) score was calculated in cats with uncomplicated sepsis and septic shock ( 18 ). Multiorgan dysfunction syndrome (MODS) was defined as the presence of at least two dysfunctional organs simultaneously, as previously reported ( 3 ) and as depicted in Table 1 . Outcome was defined as survival to hospital discharge, death or euthanasia due to grave prognosis.…”

“…Sepsis, the life-threatening organ dysfunction caused by a dysregulated host response to infection, is a global health burden affecting critically-ill people and veterinary patients (1)(2)(3). According to the Third International Consensus Definition Sepsis-3 septic shock is defined as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone.…”

“…In small animals, septic shock is defined as a state of fluidrefractory hypotension requiring vasopressor support and is reportedly associated with higher mortality rates compared to uncomplicated sepsis (3,(12)(13)(14)(15). However, feline septic shock is not commonly investigated (3,15), and the stratification and the prognostic impact of the different septic shock phenotypes based on hyperlactatemia and fluid-refractory hypotension have not yet been documented.…”

Veterinary perspective of the renal system in sepsis

“…La lesión renal aguda (LRA) se considera la complicación orgánica más frecuente y letal secundaria a la sepsis, ocurre en 30 a 50% de las personas afectadas (4,5,6,7); en 32,5% de los gatos siendo asociada a un mayor riesgo de mortalidad (8); y en 12% de los perros, de los cuales apenas sobreviven el 14% (3,9). Sin embargo, la fisiopatología de esta lesión no está completamente clara, ha sido asociada a aliteraciones en el flujo sanguíneo renal (FR), la microcirculación renal o incluso a factores involucrados en la respuesta inflamatoria (6,10).…”