Diagnostic and predictive ability of hyperbilirubinemia severity in cats: A multicenter retrospective study.

BACKGROUND: Total serum bilirubin concentration (TBIL) can provide useful information on several pathophysiological conditions in cats. Nevertheless, whether the variable severity classification of hyperbilirubinemia can reliably indicate certain disease processes or predict a biliary obstruction (BO) has not been investigated. HYPOTHESIS/OBJECTIVE: Determine if hyperbilirubinemia of variable severity can assist clinicians to identify BO, which often is considered a surgical emergency. ANIMALS: Two-hundred sixteen client-owned cats. METHODS: Data were retrospectively collected from all cats (January 2015-August 2022) with an increased TBIL (>0.58 mg/dL [>10 µmol/L]) presented to 3 referral centers in the United Kingdom (UK). Presenting clinical features and diagnostic outcomes were collected. The predictive ability of TBIL to indicate BO was evaluated by multivariable binary logistic regression modeling and receiver operating characteristic (ROC) curves. RESULTS: Median TBIL was 1.73 mg/dL (range, 0.59-26.15; 29.5 µmol/L; range, 10.1-447.1) with severity classification of hyperbilirubinemia categorized as mild (>0.58-2.92 mg/dL; >10-50 µmol/L; 68.1%), moderate (>2.92-5.85 mg/dL; >50-100 µmol/L; 17.6%), severe (>5.85-11.70 mg/dL; >100-200 µmol/L; 9.7%) and very severe (>11.70 mg/dL; >200 µmol/L; 4.6%). Biliary obstruction was present in 17 (7.9%) cats, all of which received recommendation for emergency surgery. Median TBIL in cats with BO (9.69 mg/dL; 165.7 µmol/L) differed significantly from those without obstruction (1.51 mg/dL; 25.8 µmol/L; P < .01). The optimal TBIL cut-off to discriminate between cats with and without BO was ≥3.86 mg/dL (≥66 µmol/L) with a sensitivity of 94.1% and specificity of 82.4%. Using multivariable logistic regression, as age increased, the odds of BO increased significantly (odds ratio, 1.20; 95% confidence interval, 1.01-1.42; P = .04). CONCLUSIONS AND CLINICAL IMPORTANCE: As part of a thorough clinical assessment, the severity classification of hyperbilirubinemia has the potential to predict the likelihood of a BO and to discriminate between cats that may or may not require surgery for BO at a suggested cut-off of ≥3.86 mg/dL (≥66 µmol/L). Alongside TBIL, age is also useful when assessing for the likelihood of BO in a cat presented with hyperbilirubinemia.

A UK-based survey of cat owners' perceptions and experiences of antibiotic usage.

OBJECTIVES: The aim of this study was to explore owners' knowledge of antibiotics, experience of antibiotic use in their cats and involvement in decision-making regarding antibiotic prescriptions. METHODS: Cat owners were recruited via social media and veterinary practices to complete a survey designed to evaluate general knowledge of antibiotics, attitudes to antibiotic stewardship and experiences of antibiotic use in their own cat between November 2017 and March 2018. Data were analysed descriptively. RESULTS: A total of 1436 surveys were completed; 247 respondents (17.2%) had a veterinary background. The majority of the remaining respondents correctly identified that antibiotics treat bacterial infections (84.0%; n = 999) but do not treat viral infections (72.8%; n = 865). A minority (n = 338; 28.4%) agreed that antibiotic resistance was a problem in cats in the UK; 92.3% (n = 1097) identified that resistance was a problem in human medicine. Seventy percent (n = 832) of the respondents' cats had received antibiotics; 29.6% (n = 246) received a long-acting injectable antibiotic (14 days' duration). Diagnostic tests were performed before antibiotic prescription in 38.7% (n = 322) of cats; 1.4% (n = 7) of respondents reported declining suggested tests and 65.8% (n = 778) indicated that they would be happy to pay for diagnostic tests to allow selection of the most appropriate antibiotic. Most respondents (95.8%; n = 792) indicated that they were happy to follow their veterinarian's advice and recommendations; however, 49.2% (n = 405) had expected antibiotics to be prescribed. CONCLUSIONS AND RELEVANCE: Cat owners demonstrated good knowledge of antibiotic action; however, greater owner education regarding the potential for veterinary antibiotic resistance, requirement for diagnostic testing and training in the administration of oral medication with first-line antibiotics, as well as the use of veterinary antibiotic guidelines, will improve antibiotic stewardship. Good communication between veterinarians and owners is necessary for rational antibiotic use.