Use of admission serum neutrophil gelatinase-associated lipocalin (NGAL) concentrations as a marker of sepsis and outcome in neonatal foals.

BACKGROUND: Equine neonatal sepsis can be challenging to diagnose and prognosticate. Neutrophil gelatinase-associated lipocalin (NGAL), a new marker of renal damage and inflammation, can potentially be helpful. OBJECTIVES: To evaluate NGAL in neonatal foals with sepsis, and assess its relation to outcome. ANIMALS: Foals ≤ 14 days, with admission blood analysis and stored serum. METHODS: NGAL was measured on stored serum from 91 foals. Foals were scored for sepsis and survival and categorized according to sepsis status (septic, sick non-septic, healthy, and uncertain sepsis status) and outcome groups (survivors and non-survivors). The septic foals were further sub-categorized according to severity (normal sepsis, severe sepsis and septic shock). A Kruskal-Wallis test was used to compare serum NGAL concentrations in survivors and non-survivors, in the sepsis status groups, and in the sepsis severity groups. Optimal cut-off values for serum NGAL concentrations to diagnose sepsis and outcome were determined with receiver operating characteristic (ROC) curves. NGAL was compared to creatinine and SAA. RESULTS: Median serum NGAL concentrations were significantly higher in septic than non-septic foals. However, serum NGAL concentrations did not differ between sepsis severity subgroups. Serum NGAL concentrations were significantly lower in survivors than in non-survivors. Optimal cut-off values of serum NGAL concentrations were 455 µg/L (sensitivity 71.4%, specificity 100%) and 1104 µg/L (sensitivity 39.3%, specificity 95.2%) for predicting sepsis and non-survival, respectively. NGAL correlated to SAA, but not to creatinine. NGAL performed similarly to SAA to diagnose sepsis. CONCLUSION: Serum NGAL concentrations may be useful for diagnosing sepsis and predicting outcome.

Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals.

BACKGROUND: Serum amyloid A (SAA) has been reported to hold promise as diagnostic and prognostic marker in foals. This has not been investigated thoroughly. OBJECTIVES: Evaluate admission SAA concentrations as predictor of sepsis and outcome. ANIMALS: Five hundred and ninety hospitalized foals <14 days old. METHODS: Retrospective multicenter study. Foals were scored with sepsis and survival scores, grouped according to health category (septic, sick but nonseptic, uncertain sepsis status) and outcome; septic foals were further categorized according to severity (normal sepsis, severe sepsis, and septic shock). SAA was compared between groups using Mann-Whitney test and Kruskal-Wallis test. Receiver operating characteristic curves identified optimal SAA cut off values for detecting sepsis and predicting outcome. RESULTS: Admission SAA concentrations differed significantly between sick nonseptic foals (312.1 ± 685.4 mg/L) and septic foals (1079.7 ± 1254.5 mg/L) and increased with increasing sepsis score. SAA did not differ between sepsis severity groups. The optimal cut off for sepsis detection was 1050 mg/L (sensitivity 30.2%, specificity 90.7%). Admission SAA concentrations were lower in surviving (435.0 ± 723.6 mg/L) compared to nonsurviving foals (1062.7 ± 1440.1 mg/L) and decreased with increasing survival score. The optimal cut off for nonsurvival prediction was 1250 mg/L (sensitivity 22.1%, specificity 90.8%). CONCLUSIONS AND CLINICAL IMPORTANCE: SAA concentration was higher in septic foals and nonsurviving foals. Even though optimal cut offs for SAA to detect sepsis and predict outcome had low sensitivity, they had good specificity. SAA can therefore be used as a marker to rule out sepsis and nonsurvival.

Blood glucose and subcutaneous continuous glucose monitoring in critically ill horses: A pilot study.

This pilot prospective study reports the feasibility, management and cost of the use of a continuous glucose monitoring (CGM) system in critically ill adult horses and foals. We compared the glucose measurements obtained by the CGM device with blood glucose (BG) concentrations. Neonatal foals (0-2 weeks of age) and adult horses (> 1 year old) admitted in the period of March-May 2016 with clinical and laboratory parameters compatible with systemic inflammatory response syndrome (SIRS) were included. Glucose concentration was monitored every 4 hours on blood samples with a point-of-care (POC) glucometer and with a blood gas analyzer. A CGM system was also placed on six adults and four foals but recordings were successfully obtained only in four adults and one foal. Glucose concentrations corresponded fairly well between BG and CGM, however, there appeared to be a lag time for interstitial glucose levels. Fluctuations of glucose in the interstitial fluid did not always follow the same trend as BG. CGM identified peaks and drops that would have been missed with conventional glucose monitoring. The use of CGM system is feasible in ill horses and may provide clinically relevant information on glucose levels, but there are several challenges that need to be resolved for the system to gain more widespread usability.

Lawsonia intracellularis associated equine proliferative enteropathy in Danish weanling foals.

BACKGROUND: Lawsonia intracellularis, an obligate intracellular bacterium, causes equine proliferative enteropathy, mainly in horses around weaning. This disease is rarely reported in the Scandinavian countries. RESULTS: Five cases of equine proliferative enteropathy were diagnosed between 2008-2016 at the University of Copenhagen Large Animal Teaching Hospital. Cases were Danish Warmbloods and a Friesian horse, aged 6-7 months, presenting with typical clinical signs of lethargy, poor body condition, pyrexia and diarrhea. Clinical pathology was consistent with previous reports of severe hypoalbuminemia and leukocytosis. Diagnosis was confirmed by fecal polymerase chain reaction, serum immunomonolayer peroxidase assay and/or immunofluorescence and fluorescence in situ hybridization performed on formalin-fixed ileum samples. Concurrent intestinal parasitism was present in all five cases. Treatment consisted of antimicrobial therapy, anti-inflammatories, intravenous crystalloids and plasma. Three foals were euthanised due to deterioration and poor response to treatment, one with complications of septic arthritis and Strongylus vulgaris associated intestinal infarct. The other two foals survived and were reported by the owners to be healthy on long-term follow-up. CONCLUSIONS: Equine proliferative enteropathy is a disease to consider in young horses presenting with diarrhea and hypoproteinemia in Denmark.