Journals

Question 1

In a study by Guieu et al evaluatling the concentration of abdominal fluid/serum amino-terminal pro-C-type natriuretic peptide in dogs with septic peritonitis, what were the major findings?

Guieu et al. Serial evaluation of abdominal fluid and serum amino terminal pro-C-type natriuretic peptide in dogs with septic peritonitis. JVIM 2015 29.

Answer 1

• Serum NT-proCNP has been shown as a possible biomarker for sepsis, however, its sensitivity to diagnose dogs with septic peritonitis is low, thought to be because it may compartmentalize in the abdominal cavity.
• This study evaluated serial concentrations of serum NT-proCNP along with abdominal fluid concentrations with an ELISA.
• Found that the ELISA was able to successfully measure NT-proCNP in canine abdominal fluid and it consistently remained lower than the serum levels throughout the study period, essentially eliminating the theory of abdominal compartmentalization as a cause for the decreased levels.

Question 2

What were the major conclusions of a study by Cortellini et al evaluating NGAL in dogs with sepsis?

Cortellini et al. Neutrophil Gelatinase-Associated Lipocalin in dogs with sepsis undergoing emergency laparotomy: a prospective case-control study. JVIM 2015. 29.

Answer 2

• NGAL is a protein whose production is highly upregulated with epithelial cell damage; concentration in urine increases 24-72 hours before serum creatinine, which enables earlier detection of AKI. Plasma/urine NGAL increased in people with sepsis.
• Study measured serum/urine NGAL for detecting AKI in dogs with sepsis undergoing ex lap as compared to healthy dogs with IVDD surgery.
• sNGAl was significantly higher in the study dogs at all time points, as was urine NGAL (normalized to creatinine).
• Dogs that received any hydroxyethyl starch (at any time point) had a significantly higher UNCR (however, must be interpreted with caution as UNCR was higher in these patients even pre-op, prior to any HES administration)
• sNGAL was not associated with mortality or corrleated with the severity of disease as assessed by APPLE or MODS development.

Question 3

What were the major conclusions of a study by Hamacher et al evaluating serum cTnI concentrations in dogs with SIRS?

Hamacher et al. Serum cTnI concentrastions in dogs with SIRS. JVIM 2015. 29.

Answer 3

• cTnI concentrations can predict myocardial injury, which appears to be a predictor of short term death in critically ill patients, however, it is not known if the best time to measure is at admission or other time points.
• Study measured cTnI in dogs with SIRs at admission and for several days afterwards.
• Found that 41 dogs with SIRS that survived 28 days had a significantly lower cTnI concentration at admission than the 19 dogs who did not survive.
• Area under the curve to predict survival was similar at admission and at the peak time point, correlated with a 0.754 APPLEfast score.
• Increased cTnI in dogs with SIRS is associated with a poor outcome; daily follow up measurement provides no additional prognostic information for short-term mortality.

Question 4

In a study by Starkey et al reporting on persistent ehrlichia ewingii infection in dogs after natural tick infestation, what were the major findings?

Starkey et al. Persistent ehrlichia ewingii infection in dogs after natural tick infestation. JVIM 2015 29.

Answer 4

• Intermittent E. ewingii rickettsemia persisted in 3 of 4 dogs for as long as 733 days.
• Dogs infected with E. ewingii from tick feeding are capable of maintaining infection with this pathogen long-term and may serve as a reservoir host for the maintenance of E. ewingii in nature.

Question 5

What were the major findings of a study by Burton et al examining the use of a degenerative left shift as a prognostic indicator in cats?

Burton et al. Degenerative left shift as a prognostic tool in cats. JVIM 2014 28.

Answer 5

• A DLS occurs when immature granulocyte precursors outnumber mature neutrophils.
• In this study, cats with a DLS were 1.57 times more likely to die or be euthanized than cats without.
• An increasing severity of DLS is associated with increased likelihood of death or euthanasia.
• FeLV infected cats had a 3x higher risk of death or euthanasia than cats presented for any other reason
• Purebred cats had a 1.3x lower risk of death/euthanasia than other breeds

Question 6

What were the major conclusions of a study by Langhorn et al examining the value of cardiac troponins in dogs with SIRs as predictors of long-term outcome?

Langhorn et al. Prediction of long-term outcome by measurement of serum concentrations of cardiac troponins in critically ill dogs with systemic inflammation. JVIM 2014 28.

Answer 6

• Myocardial injury detected by cTnI and cTnT has been associated with longterm death in the noncardiac human intensive care unit.
• In dogs admitted to the ICU with evidence of systemic inflammation, blood samples were obtained for troponin measurement at admission and once daily throughout stay.
• One year case fatality rate was 47%, with non-survivors having significantly higher concentrations of cTnI and cTnT at all time points than survivors.
• Optimal cutoff, 1.17ng/mL peak cTnI and 23 ng/L admission CtnT.
• Sensitivity and specificity for both low (72%/70% for cTnI and 72%/80% cTnT)
• Troponins significantly related to 1 year case fatality, however, low sensitivities and specificities prevent their prediction of long term outcome in individual patients.

Question 7

What were the major conclusions of a study by Floras et al evaluating nTproCNP concentrations in dogs with endotoxemia?

Floras et al. N Terminal Pro-C-Natriuretic Peptide and cytokine kinetics in dogs with endotoxemia. JVIM 2014 28

Answer 7

• Healthy research dogs given LPS or placebo; NTpCNP measured by ELISA as were cytokines/chemokines.
• Serum NTpCNP did not differ significantly between the LPS or placebo group at any time point.
• Certain serum cytokines/chemokines are significantly increased within 1-4 hours of LPS administration in healthy dogs and warrant further investigation as tools for detection/management of sepsis in dogs.

Question 8

What were the major findings of a study by Foy et al examining the utilityof serum and urine blasto antigen concentrations as markers of clinical remission in dogs treated for systemic blasto?

Foy et al. Serum and urine blasto antigen concentrations as markers of clinical remission in dogs treated for systemic blastomycosis. JVIM 2014 28.

Answer 8

• At enrollment, blasto urine antigen was positive in 21/21 dogs and serum 18/20.
• At 2-4 months of treatment, blasto urine antigen was more sensitive for clinically detectable disease.
• Urine blasto antigen testing has high sensitivity for active disease at the time of diagnosis and during treatment and moderate sensitivity with high specificity for clinical relapse.
• Urine testing should be used.

Question 9

What were the major findings in a case report by Friedenberg et al detailing a unique presentation of Bartonella in a dog?

Friedenberg et al. Splenic vasculitis, throbmosis, and infection in a febrile dog infected with Bartonella henselae. JVECC 2015 25.

Answer 9

• Dog presented for limping, fever, vomiting, malaise.
• Nonocclusive splenic vein thrombus identified, with histopathology of the spleen showing marked splenic infarctions and necrotizing vasculitis.
• Bartonella was amplified by PCR and the dog recovered uneventfully with antimicrobial therapy.
• Ideal treatment for bartonella (erythrocytic/endotheliotrophic bacteria) is not known, typically treated with multiantimicrobial therapy (enrofloxacin, doxycycline in this case)
• Bartonella may play a role in the development of vasculitis and thromboembolism and as such, should remain a differential in cases of splenomegaly/thrombus.

Question 10

What were the major conclusions from a study by Torrente et al evaluation plasma iron, CRP and albumin concentrations in dogs with SIRS?

Torrente et al. Plasma iron, CRP, albumin and plasma fibrinogen concentrations in dogs with SIRS. JVECC 20150 25.

Answer 10

• Plasma iron has been shown to decrease in inflammatory conditions in both animals and people
  
  • Decrease in iron is thought to be mediated by hepcidine, produced by the liver in response to inflammatory cytokines
  • Induces the loss of ferroportin in different cell types and inhibits the export of iron from the cellular compartment to plasma
  • Progressive decrease in plasma iron input and the continued use of transferrin-bound iron results in hypoferremia.
• Fibrinogen was increased in the dogs with SIRS/sepsis and local inflammation as compared to controls, but no significant difference btwn the 2 groups with inflammation
• Plasma iron, CRP, and albumin all effectively differentiated dogs with SIRs/sepsis from those with local inflammation on presentation
• Admission values did not discriminate survivors from non-survivors
• Magnitude of increase in plasma iron and magnitude of decrease in CRP were higher in survivors than nonsurvivors within the SIRs/sepsis gropu.
• Concluded that hypoferremia is a sensitive marker of systemic inflammation in dogs
  
  • An increase in iron during the hospitalization period was associated with a better prognosis
  • Plasma iron in combination with CRP and albumin concentrations may be a useful monitoring tool

Question 11

What wer the major conclusions of a study by Cortellini et al examining plasma lactate concentrations in septic peritonitis?

Cortellini et al. Plasma lactate concentrations in septic peritonitis: a retrospective study of 83 dogs (2007-2012). JVECC 2015 25 3.

Answer 11

• Plasma lactate concentration is relevant in assessment of the degree of overt or occult hypoperfusion as well as in assessment of tissue DO2 (end product of anaerobic metabolism and circulating concentrations increased underconditions of tissue hypoxia)
• “Lactime”–time lapsed from admisison to normalization of plasma lactate concentration
• Admission plasma lactate >2.5mmol/L was associated with mortality, with a significantly higher lactate in nonsurvivors than survivors
  
  • Patients with a higher median lactate were more likely to require transfusion/vasopressors
• Plasma lactate clearance at 6 and 12 hours after admission was also a good predictor of mortality (lactate >2.3 and 2.4 ;specificity 92% and 100%)
• Admission plasma lactate concentration and lactate clearance (in particular) within a 6-12 hour window is associated with survival and persistent postoperative hyperlactatemia should raise concern.

Question 12

What were the major conclusions of a study by Guinti et al regarding the APPLE score and labwork in dogs with SIRS?

Guinti et al. Prospective evaluation of the APPLE score and an extended clinicopathological profile in dogs with SIRs. JVECC 2015 25 2.

Answer 12

• No significant difference in bloodwork and APPLEfast scores were found
• Survivors had significantly higher:
  
  • Total protein
  • Albumin
  • Antithrombin
  • Base excess
• Survivors had significantly lower:
  
  • Lactate
  • Urea
  • Creatinine
  • APPLEfast scores (22 compared to 31)
• Higher values of: creatinine, lactate, anion gap, APPLEfast, and ALT were significantly associated with an increased risk of death

Question 13

What were the conclusions of a study by Dickinson et al regarding appropriate antimicrobial therapy on outcome in dogs with septic peritonitis?

Dickinson et al. Impact of appropraite antimicrobial therapy on outcome of dogs with septic peritonitis. JVECC 2015 25 1.

Answer 13

• The results of this study failed to demonstrate an improved survival rate in those patients who were administered appropriate empiric antimicrobial therapy in this patient population.
• Prior treatment with antimicrobials did not show an association with outcome, however, was associated with a subsequent inappropriate antimicrobial choice
• Recent abdominal surgery was also associated with a subsequent inappropriate antimicrobial choice
• Study is small however, doesn’t fit with results of large meta-analyses in people (i.e. survival 52% in people with appropriate antimicrobials, 10% survival in patients with inappropriate antimicrobials)

Question 14

What were the major conclusions of a review by Keir and Dickinson regarding the role antimicrobials in the treatment of sepsis?

Keir and Dickinson. The role of antimicrobials in the treatment of sepsis and critical illness related bacterial infections. JVECC 2015 25 1.

Answer 14

• The SSC guidelines strongly supports the administration of IV antibiotics within the first hour of recognition of septic shock and sepsis, with survival decreasing by 7.6% for every hour delay in administering appropriate antimicrobials; patients not receiving appropriate antimicrobials until >36 hours had 5% survival.
• The available veterinary literature does not support this finidng, with two studies failing to demonstrate improved survival in patients with pulmonary/abdominal infections given appropriate versus inappropriate antimicrobials.
• One study failed to show improved survival in dogs with abdominal infections when given antibiotics within 1 hour versus 6 hours of diagnosis of infection.
• “The ability to administer early and appropriate antimicrobials may be considered a measure of the quality of medical practice rather than a prognostic indicator”

Question 15

What were the major findings from a case report by Tobelman et al detailing heterotropic gastric mucosa in a puppy?

Tobelman and Sinnot. Heterotropic gastric mucosa associated with abdominal abscess formation, hypotension and acute abdominal pain in a puppy. JVEC 2014 24 6.

Answer 15

• A puppy presented for hypotension and GI signs, with a fluid filled mass associated with the mid-jejunum identified on AUS.
• Ex lap removed the tissue which was shown to be heterotropic gastric mucosa and abscessation with growth of e.coli.
• First report of abscess formation

Question 16

What were the major findings of a study by Ateca et al examining organ dysfunction and mortality risk in dogs following bite wound trauma?

Ateca et al. Organ dysfunction and mortality risk factors in severe canine bite wound trauma. JVECC 2014 24 6.

Answer 16

• The overall mortality rate in this study was 15%
• Longer duration of anesthesia was associated with mortality
• SIRS developed in 54% of the dogs and was significantly associated with mortality, with a mortality rate of 24% in dogs that developed SIRS
• MODS developed in 27% of dogs and was significantly associated with mortality. A mortality rate of 67% was evident in dogs with dysfunction of 4 or more organs.
• The respiratory system was most commonly affected
• Cardiovascular dysfunction was highly predictive of mortality, as were coagulation and pancreatic dysfunction, a diagnosis of SIRS, and respiratory and hepatic dysfunction.

Question 17

What were the major conclusions from a study evaluating the instilled volume necessary for standardized intra-abdominal pressure monitoring by Way et al?

Way et al. Determination and validation of volume to be instilled for standardized intra-abdominal pressure measurement in dogs. JVECC 2014 24 4.

Answer 17

• 1ml/kg instilled saline is recommended for standardized IAP measurement in dogs.
• IAP in clinically normal dogs was not affected by abdominal surgery

Question 18

What were the findings of a study by Liao et al regarding postoperative CRP levels in dogs with pyometra treated with low-dose ketamine?

Liao et al. Decreased post-operative CRP production in dogs with pyometra through the use of low dose ketamine. JVECC 2014 24 3.

Answer 18

• Ketamine is an NMDA receptor antagonist with sympathomimetic properties
  
  • Has been shown to improve survival and decreased production of TNFalpha and IL6 with use
• In dogs with pyometra treated with a low dose ketamine CRI, the serum cocnetrations of CRP were significantly increased in the control group compared to decreased in the ketamine gropu at 48 hours after surgery
• No significant difference in survival to discharge/length of hospitalization

Question 19

What were the major conclusions of a study by Pashmakova et al evaluating serum thyroid hormone levels in dogs with SIRS or sepsis?

Pashmakova et al. Evaluation of serum thyroid hormones with systemic inflammatory response syndrome or sepsis. JVECC 2014 24 3.

Answer 19

• Decreased total thyroxine (TT4) were documented in all dogs with sepsis/SIRs
• No relationships were identified between thyroid hormone concentrations and survival
• Dogs with increased APPLEfast scores were less likely to survive

Question 20

What were the major conclusions of a study by Gauthier et al regarding the effect of administration of synthetic colloids on hemodynamic/lab variables in dogs with SIRS?

Gauthier et al. Effect of synthetic colloid administration on hemodynamic and laboratory variables in healthy dogs and dogs with inflammation. JVECC 2014 24 3.

Answer 20

• In healthy dogs, administration of both NaCl and tetrastarch resulted in a decrease in PCV/TP. Tetrastarch caused a larger immediate increase in HR/SBP and MAP compared to NaCl.
• In dogs with LPS induced inflammation, increased HR and MAP with tetrastarch. PCV/TP and lactate decreased with both fluids.
• Tetrastarch effectively increased COP (as compared to decreased with NaCl) in all dogs, although the total plasma protein decreased…

Question 21

What were the major conclusions of a study by Langhorn et al evaluating myocardial injury in dogs with snake bites and systemic inflammation?

Langhorn et al. Myocardial injury in dogs with snake envenomation and its relation to systemic inflammation. JVECC 2014 24 2.

Answer 21

• Envenomation by viperinae can induce myocardial injury/arrhythmias–it is unknown if this arises due to a direct cardiotoxin or secondary to SIRS induced by toxins.
• Dogs envenomated by V. berus had significant increases in cTnI compared to healthy dogs at 12 and 24 hours post admission.
  
  • Dogs that also had a CRP of >35mg/dL at admit and 12-24 hours post had significantly higher cTnI than those with lower CRPs and normal dogs
  • No significant difference between dogs with/without arrhythmias
• Significant increases in cTnI and CRP at all time points in dogs envenomated by B. arietans and N. annulifera, but no correlation between cTnI and CRP at any point.
  
  • Could be due to differences in toxic substances of the snake venoms or differences in the cytokines induced by the bites.
• Myocardial injury occurs frequently in dogs with snake bite injury and may be a negative prognostic indicator.
  *

Question 22

What were the primary findings of a study by Koenig et al regarding glucose concentrations in various body fluids for diagnosis of septic peritonitis?

Koenig et al. Usefulness of whole blood, plasma, peritoneal fluid, and peritoneal fluid supernatant glucose concentrations obtained by a veterinary point of care glucometer to identify septic peritonitis in dogs with peritoneal effusion. JAVAM 2015 247.

Answer 22

• Whole blood/peritoneal fluid glucose cutoff of >20mg/dL (historical “standard”) was NOT a sensitive indicator of septic peritonitis (sensitivity 42%, specificity 100%)
• With a glucose concentration difference of >38mg/dL for plasma-peritoneal fluid or plasma-peritoneal fluid supernatant, there was support for an accurate diagnosis of septic peritonitis in dogs and cats.

Question 23

What were the findings of a study by Fukumoto et al regarding Big endothelin-1 as a tumour marker for canine HSA?

The Vet Journ 2015

Answer 23

• Serum big ET-1 was elevated in dogs with HSA significantly compared to other dogs.

Question 24

What were the findings of a study by Proksch et al regarding the influence of clinical and laboratory variables on fecal antigen ELISA results in dogs with canine parvovirus infection?

The Vet Journ 2015 204

Answer 24

• 51.3% had a false negative fecal antigen ELISA result
• ELISA negative dogs had a significantly shorter time until presentation, lower frequency of defecation, lower fecal virus load, and higher serum antibody concentrations than ELISA positive dogs.
• Low fecal CPV load and antibodies binding to CPV antigen in feces are likely to be important reasons for false negative results

Question 25

What were the findings of a study by DeClue et al regarding the effects of opioids on phagocytic function, oxidative burst capacity, cytokine production and apoptosis in canine leukocytes?

Vet Journ 2014

Answer 25

• Morphine, buprenorphine and fentanyl all promoted LPS or LTA-induced TNF alpha and IL-10 production, but did not actually alter the ratios of these cytokines
• Morphine, buprenorphine and fentanyl all inhibited neutrophil apoptosis, which was not concentration dependent in nature
• Opioids alter immune and apoptotic pathways in dogs and these effects should be considered when designing studies and interpreting outcomes of studies involving opioid administration

Question 26

What were the findings by Babyak and Sharp on the epidemiology of SIRS and sepsis in cats hospitalized in a VTH?

JAVMA 2016 249

Answer 26

• Prevalence of sepsis at hospital admission was 6.2 cases/100 admissions.
• Mortality rate was 33.3% for septic cats.
• Results indicated that many cats have evidence of SIRS and some have sepsis, with a high mortality rate

Question 27

What were the findings of a study by Cleveland and Casale on the incidence of malignancy and outcomes for dogs undergoing splenectoy for incidentally detected nonruptured splenic nodules or masses: 105 cases?

JAVMA 2016 248

Answer 27

• 70.5% of lesions were benign, 29.5% were malignant neoplasia (58% of which were HSA)
• Median life expectancy of dogs with HSA was 132 days, only 7 of the dogs received any adjunct chemo
• Life expectancy for the dogs with incidentally detected lesions that received prompt intervention was better than has been previously reported for other studied populations

Question 28

What were the findings of a study by DeGroot et al regarding primary splenic torsion in 102 dogs?

JAVMA 2016 248

Answer 28

• 91.2% survival to discharge rate
• GSD, Great Danes and English Bulldogs accounted for 50% of the cases
• Septic peritonitis on presentation, intraoperative hemorrhage and postoperative development of respiratory distress were associated with death
• Splenic neoplasia was not found on histopath in any case

Question 29

What were the findings of a study by Bellini and Seymour on the effect of intraoperative CRI of lidocaine on short term survival of dogs with septic peritonitis (75 cases)?

JAVMA 2016 248

Answer 29

• Proportion of dogs that survived for 48 hours after surgery was significantly higher for the patients treated with lidocaine (35/42) than for those treated with an opioid alone (20/33).
• Intraoperative lidocaine increased the odds of short-term survival.
  *

Question 30

What were the findings of a study by Eichenberger et al regarding prognostic markers in acute Babesia canis infection?

JVIM 2016 30

Answer 30

• Poor outcome in acute B. canis may be suspected in dogs presenting with moderate anemia, severe thrombocytopenia, mild/moderate leukopenia, hyperlactatemia, moderately increased serum phosphate and triglyceride concentrations and moderately decreased total serum protein concentrations

Question 31

What were the findings of a study by Barfield et al regarding retrospective evaluation of recurrent secondary septic peritonitis in dogs: 41 cases?

JVECC 2016 26 (2)

Answer 31

• No significant prognostic indicators for dogs with recurrent peritonitis were identified
• The mortality rate for dogs having more than one surgery for septic peritonitis is similar to that reported for a single surgery for septic peritonitis (44%)