Clinical, hematologic, hemostatic, and serum biochemical findings related to survival in Arabian horses with colic.

BACKGROUND: The efficacy of clinical examinations, and hematologic, hemostatic, and serum biochemical assessments to determine appropriate early medical or surgical therapy in Arabian horses with colic have not been well-described. OBJECTIVES: We aimed to evaluate clinical and hematologic findings, coagulation-fibrinolytic parameters, and organ dysfunction markers in association with survival in horses with colic. METHODS: Seventeen Arabian horses with colic and ten healthy horses were enrolled. After clinical examinations, including heart rates (HRs), capillary refill times (CRTs), abdominal sounds, rectal palpations, and nasogastric (NG) reflux assessments in both healthy and diseased horses, blood samples were collected and hematologic parameters, coagulation indices such as the prothrombin time (PT), activated partial thromboplastin time (APTT), plasma d-dimer (PDD), platelet count, fibrinogen, and hepatorenal biomarkers were measured. Based on the outcomes, horses with colic were divided into survival (10) and nonsurvival (7) groups, and all mentioned parameters were compared with the control group horses. RESULTS: Unlike HRs, CRTs, and abdominal sounds, rectal palpations (57.1%) and NG reflux (28.6%) findings were least sensitive in being able to determine survival. At least three of the five coagulation indices were significantly abnormal (prolonged PT, increased PDD, and decreased plasma fibrinogen) in 71.4% of the horses in the nonsurvival group compared with the control and survival groups. Significantly increased urea, creatinine, and bilirubin levels, and AST activities were also observed in the survival group compared with the control and nonsurvival groups. CONCLUSIONS: The combination of prolonged PT, increased PDD, and hypofibrinogenemia could be a reliable predictor of survival in horses with colic. The significant renal and hepatic dysfunctions in nonsurviving horses with colic appeared to be consistent with disseminated intravascular coagulation (DIC) and a grave prognosis.

Neonatal Antibiotic Treatment Is Associated With an Altered Circulating Immune Marker Profile at 1 Year of Age.

Background: Neonatal antibiotics disturb the developing gut microbiome and are therefore thought to influence the developing immune system, but exact mechanisms and health consequences in later life still need to be elucidated. Therefore, we investigated whether neonatal antibiotics influence inflammatory markers at 1 year of age. In addition, we determined whether health problems during the first year of life, e.g., allergic disorders (eczema and wheezing) or infantile colics, were associated with changes in the circulating immune marker profile at 1 year of age. Methods: In a subgroup (N = 149) of the INCA-study, a prospective birth-cohort study, a blood sample was drawn from term born infants at 1 year of age and analyzed for 84 immune related markers using Luminex. Associations of antibiotic treatment, eczema, wheezing, and infantile colics with immune marker concentrations were investigated using a linear regression model. The trial is registered as NCT02536560. Results: The use of broad-spectrum antibiotics in the first week of life, was significantly associated with different levels of inflammatory markers including sVCAM-1, sCD14, sCD19, sCD27, IL-1RII, sVEGF-R1, and HSP70 at 1 year of age. Eczema was associated with decreased concentrations of IFNα, IFNγ, TSLP, CXCL9, and CXCL13, but increased concentrations of CCL18 and Galectin-3. Wheezing, independent of antibiotic treatment, was positively associated to TNF-R2 and resistin. Infantile colics were positively associated to IL-31, LIGHT, YKL-40, CXCL13, sPD1, IL1RI, sIL-7Ra, Gal-1, Gal-9, and S100A8 at 1 year of age, independent of early life antibiotic treatment. Conclusion: In this explorative study, we identified that neonatal antibiotics are associated with immunological alterations at 1 year of age and that, independent of the antibiotic treatment, infantile colics were associated with alterations within gut associated markers. These findings support the importance of the first host microbe interaction in early life immune development.

Predictors of bile tree pathology in patients presenting with gallbladder disease.

BACKGROUND: Patients with gallstone disease can present with elevated liver function tests (LFTs). It is often challenging to differentiate those with a common bile duct (CBD) stone from those without a CBD stone on the basis of the LFTs levels. In this study, we aim to evaluate the predictors of a CBD stones among patients presenting with symptomatic gallbladder disease and elevated LFTs. PATIENTS AND METHODS: We retrospectively examined all patients who had undergone a cholecystectomy between January 2010 and December 2015. Patients with symptomatic cholelithiasis and increased LFTs were included. Patient characteristics, imaging findings, lab findings, endoscopic interventions, and operative report were recorded and evaluated. The diagnosis of CBD stones was made on the basis of ERCP and IOC findings. RESULTS: We included 354 patients in the final analysis. Of these, 113 (32%) had confirmed choledocholithiasis. The prevalence of CBD stones among biliary colic, acute cholecystitis, and pancreatitis patients was 47, 25, and 26%, respectively. γ-Glutamyl transferase and direct bilirubin had the highest sensitivities for CBD stones among these patients (83 vs. 79%). In the setting of biliary colic, total bilirubin was highly predictive of CBD stones with a positive predictive value of 85%. In the setting of acute cholecystitis, elevated LFTs were even less significant in predicting stones, with a positive predictive value of less than 40% for most. CONCLUSION: Although γ-glutamyl transferase and bilirubin levels showed a relatively higher sensitivity for CBDS compared with the other LFTs, these were not reliable enough because of high false-positive as well as false-negative values, especially in patients presenting with acute cholecystitis.

Evaluation of serum amyloid A and haptoglobin concentrations as prognostic indicators for horses with colic.

OBJECTIVE: To evaluate the use of the acute-phase proteins serum amyloid A (SAA) and haptoglobin as prognostic indicators in horses with colic with regard to the need for surgical intervention, development of complications, and hospitalization cost and duration. DESIGN: Prospective observational study. ANIMALS: 20 clinically normal horses and 42 horses with colic. PROCEDURES: Total WBC and neutrophil counts and plasma fibrinogen, SAA, and haptoglobin concentrations were compared between healthy (control) horses and horses admitted to a veterinary teaching hospital for colic. Clinicopathologic values were compared between medical and surgical colic cases to test the ability of acute-phase proteins to predict indication for surgical intervention, development of complications, and duration and cost of hospitalization. RESULTS: Mean SAA concentration was significantly higher in the surgical group, compared with that for both the control and medical groups. Haptoglobin concentration did not differ significantly among groups. Horses with colic and an abnormally increased SAA concentration (> 5 µg/mL) were more likely to be managed surgically than medically (OR, 5.7; 95% confidence interval, 1.4 to 22.8). Horses with small intestinal lesions had significantly higher SAA concentrations than did control horses. Euthanasia due to a poor prognosis or the development of thrombophlebitis was more likely for horses with an SAA concentration > 5 µg/mL (OR, 7.6; 95% confidence interval, 1.1 to 52.4). A weak positive correlation (r = 0.30) was observed between cost of treatment and SAA concentration. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with colic that had an abnormally increased SAA concentration were more likely to require surgical intervention, develop thrombophlebitis, or be euthanized because of a poor prognosis despite treatment.

Increased serum nonesterified fatty acid and low ionised calcium concentrations are associated with post partum colic in mares.

REASONS FOR PERFORMING STUDY: Increased serum nonesterified fatty acids (NEFA) and decreased serum electrolytes are linked to abdomasal displacements in post partum dairy cattle. Post partum colic in mares may be associated with metabolic changes specific to pregnancy and the periparturient period. OBJECTIVES: To determine if fluctuations in serum NEFA, ionised calcium (iCa) and magnesium (iMg) occurred in periparturient mares and if these alterations were associated with post partum colic. STUDY DESIGN: Longitudinal observational study. METHODS: Mares from 3 farms in central Kentucky were enrolled. Blood samples were collected 14 days prior to the estimated foaling date, within 4 days post parturition, and 14 and 28 days after foaling for batch analysis of serum NEFA, iCa and iMg. Health information was provided by farm managers and veterinarians. Data were analysed using Kruskal-Wallis χ(2) statistic for nonparametric data and a matched case/control approach. Repeated measures logistic regression models were developed. RESULTS: Serum NEFAs were higher at 14-1 day before foaling (mean ± s.d., mmol/l), 0.28 ± 0.12, P = 0.04 and from foaling to 4 days after foaling, 0.29 ± 0.20 (P = 0.05) in mares that developed colic compared with those that did not colic, 0.19 ± 0.05 and 0.21 ± 0.14, respectively. Ionised calcium was lower at 15-28 days post foaling in mares that showed colic, 1.50 ± 0.17 compared to mares that did not colic, 1.60 ± 0.12, P = 0.02. Risk of colic in post partum mares increased 38% for each 0.1 mmol/l increase in serum NEFA (odds ratio = 1.38, 95% confidence interval 1.06-1.81, P = 0.02). CONCLUSIONS: Mares with post partum colic had significantly higher serum NEFA and lower iCa prior to the colic episode compared with mares that did not develop colic. Monitoring these metabolic alterations may lead to predictive and preventive colic strategies for post partum mares.

Association Between Necropsy Evidence of Disseminated Intravascular Coagulation and Hemostatic Variables Before Death in Horses With Colic.

BACKGROUND: Disseminated intravascular coagulation (DIC) is frequent in horses with severe gastrointestinal disorders. Postmortem studies have found fibrin microthrombi in tissues of these horses, but studies relating these histopathological findings with antemortem hemostatic data are lacking. HYPOTHESIS: Antemortem classification of coagulopathy is related to the presence and severity of fibrin deposits observed postmortem in horses with severe gastrointestinal disorders. ANIMALS: Antemortem hemostatic profile data and postmortem tissue samples (kidney, lung, liver) from 48 horses with colic. METHODS: Tissue samples were stained with phosphotungstic acid hematoxylin and immunohistochemical methods for histological examination. A fibrin score (grades 0-4) was assigned for each technique, tissue and horse, as well as the presence or absence of DIC at postmortem examination. D-dimer concentration, prothrombin time (PT), activated partial thromboplastin time (aPTT), and antithrombin (AT) activity, as well as the clinicopathological evidence of coagulopathy, were determined from plasma samples collected 0-24 hours before death or euthanasia. Histologic and clinicopathologic data from the same horses were compared retrospectively. RESULTS: No association was found between antemortem classification of coagulopathy and postmortem diagnosis of DIC based on tissue fibrin deposition. None of the hemostatic parameters was significantly different between horses with or without postmortem diagnosis of DIC. There was no association between horses with fibrin in tissues or different cut-offs for D-dimer concentration and postmortem evidence of DIC. CONCLUSIONS AND CLINICAL IMPORTANCE: Abnormalities of the routine clotting profile, including D-dimer concentration, were not useful in predicting histologic evidence of DIC at necropsy in horses with severe gastrointestinal disorders.

Plasma HMGB-1 and Nucleosome Concentrations in Horses with Colic and Healthy Horses.

BACKGROUND: Acute gastrointestinal disease occurs commonly in horses. Novel biomarkers might improve the understanding of SIRS and aid diagnosis and determination of prognosis. HYPOTHESES: Increased plasma concentrations of the biomarkers HMGB-1 and nucleosomes are associated with severity of gastrointestinal lesions in horses; concentrations of these biomarkers will be greater in horses with lesions more likely to cause SIRS; and will provide additional information compared with standard biomarkers fibrinogen and SAA. ANIMALS: Thirty horses with gastrointestinal disease, 22 healthy horses. METHODS: Prospective study. Plasma samples taken on admission were used for measurement of HMGB-1, nucleosomes, fibrinogen, and SAA. Values were compared between healthy horses and those with gastrointestinal disease, and between horses with gastrointestinal disease grouped by lesion type (inflammatory, strangulating, and nonstrangulating). Correlations between biomarkers were assessed. RESULTS: Plasma concentrations of all biomarkers were significantly higher in horses with gastrointestinal disease compared to healthy horses (P ≤ .001). HMGB-1 and nucleosomes were significantly higher in inflammatory and strangulating groups compared to healthy horses (3.5-fold and 5.4-fold increases, respectively, for HMGB-1 (P < .05) and 4.8-fold and 5.6-fold increases for nucleosomes (P < .05)), but concentrations in the group with nonstrangulating disease did not differ from healthy horses. There was significant correlation between HMGB-1 and nucleosomes (Spearman's r = 0.623; P < .001), and fibrinogen and SAA (Spearman's r = 0.801; P < .001) but not between other biomarkers. CONCLUSIONS AND CLINICAL IMPORTANCE: High mobility group box-1 and nucleosomes might have use as biomarkers for horses with gastrointestinal disease. Further studies are required to determine kinetics and prognostic value of serial measurements of these biomarkers in horses.

Serum amyloid A, haptoglobin, and ferritin in horses with colic: Association with common clinicopathological variables and short-term outcome.

Equine colic may be associated with an acute phase response (APR). Measurement of acute phase proteins (APPs) allows the detection of an APR and may help clinicians in monitoring the disease; however, the role of APPs in colic is unclear. This study aimed to evaluate the clinical usefulness of serum amyloid A (SAA), haptoglobin and ferritin in combination with an extended clinicopathological profile in equine colic. The medical records of 54 horses were retrospectively selected. Horses were grouped based on outcome (survivors vs. non-survivors), diagnosis (ischaemic/strangulating vs. non-ischaemic/non-strangulating), and treatment (medical treatment vs. surgery). Laboratory data were compared, and a logistic regression analysis was performed for outcome prediction upon admission. A high percentage of horses had abnormal SAA (29/54), haptoglobin (20/54), and ferritin (31/54) concentrations. In particular, haptoglobin was below the reference interval in 13/54 horses. Non-survivors had significantly decreased haptoglobin and increased ferritin concentrations compared with survivors. The ischaemic/strangulating group had significantly increased creatinine and ferritin and decreased haptoglobin concentrations compared with the non-ischaemic/non-strangulating group. Creatinine was the only significant predictor of mortality in the regression analysis. In conclusion, APPs including SAA, haptoglobin, and ferritin combined with clinicopathological variables may help clinicians to understand the pathogenesis of APR and underline potential complications of equine colic. The reduction in haptoglobin concentration may suggest haemolysis or muscle fibre damage; ferritin may indicate alteration in iron metabolism and tissue damage. Further prospective studies are needed to assess diagnostic and prognostic values of APPs in colic horses.

Effects of preoperative administration of hypertonic saline or pentastarch solution on hematologic variables and long-term survival of surgically managed horses with colic.

OBJECTIVE: To compare the effects of preoperatively administered pentastarch (10% concentration in isotonic saline [0.9% NaCl] solution) and hypertonic saline (7.2% NaCl) solutions on PCV and circulating total protein (TP) concentration in horses with colic undergoing emergency exploratory laparotomy and to assess survival rates of horses that received each treatment. DESIGN: Prospective, randomized study. ANIMALS: 100 horses with signs of abdominal pain and PCV ≥ 0.46 L/L. Procedures-Horses received a 4 mL/kg (1.8 mL/lb) dose of pentastarch solution (n = 50) or hypertonic saline solution (50) over a 10- to 20-minute period before anesthetic induction. Blood samples were collected at the time of evaluation and ≤ 5 minutes after fluid resuscitation; changes in PCV and TP concentration were compared. Survival was evaluated by Kaplan-Meier and Cox proportional hazards analyses. RESULTS: Age, weight, sex, PCV, and heart rate on initial examination were similar between treatment groups. Hypertonic saline solution treatment resulted in a significantly greater reduction in PCV (median change, -0.14 L/L) than did pentastarch treatment (median change, -0.07 L/L). Reduction in TP concentration was also significantly greater after hypertonic saline solution treatment (median change, -16 g/L) than after pentastarch treatment (median change, -2 g/L). Long-term survival was not significantly different between groups. CONCLUSIONS AND CLINICAL RELEVANCE: Despite a greater reduction in preanesthetic hemoconcentration following administration of hypertonic saline solution (4 mL/kg infusion, once), no difference in overall long-term survival was found between horses that received this treatment and those that received an equal volume of pentastarch solution. Findings suggested that, in a clinical setting, either of these fluids would be appropriate for preoperative fluid resuscitation in horses with colic.

Influence of disease process and duration on acute phase proteins in serum and peritoneal fluid of horses with colic.

BACKGROUND: The acute phase proteins (APP) serum amyloid A (SAA), haptoglobin, and fibrinogen are valuable blood biomarkers in equine inflammatory diseases, but knowledge of factors influencing their concentrations in blood and peritoneal fluid (PF) of horses with colic is needed. OBJECTIVES: The objective of this study was to investigate the influence of demographics (age, sex, breed), disease process (simple obstruction, strangulating obstruction, inflammatory), disease location, disease duration, hypovolemia, and admission hospital on concentrations of APP, lactate and white blood cell counts (WBC) in horses with colic admitted to 2 referral hospitals. ANIMALS: The study included 367 horses with colic admitted at 2 referral hospitals. METHODS: Prospective multicenter observational study of clinical data, as well as blood and PF biomarkers. Associations between biomarker concentrations and clinical variables were analyzed using multivariate linear regression analysis. RESULTS: Increasing pre-admission duration of colic was associated with increased concentrations of APP in blood and PF. Blood concentrations of SAA and fibrinogen were associated with disease process (inflammatory, strangulations, simple obstructions) in more colic duration groups (5-12 and >24 hours) than any of the other biomarkers. No relevant associations between demographic factors, hospital, or hydration status and the measured biomarkers were found. CONCLUSIONS AND CLINICAL IMPORTANCE: In horses with colic, concentrations of APP are associated mainly with disease process and duration of colic and may thus be used for assessment of disease independently of demographic or geographic factors. Serum amyloid A may be a diagnostic marker for use in colic differential diagnosis, but further evaluation is needed.

Plasma serotonin in horses undergoing surgery for small intestinal colic.

This study compared serotonin concentrations in platelet poor plasma (PPP) from healthy horses and horses with surgical small intestinal (SI) colic, and evaluated their association with postoperative ileus, strangulation and non-survival. Plasma samples (with EDTA) from 33 horses with surgical SI colic were collected at several pre- and post-operative time points. Serotonin concentrations were determined using liquid-chromatography tandem mass spectrometry. Results were compared with those for 24 healthy control animals. The serotonin concentrations in PPP were significantly lower (P < 0.01) in pre- and post-operative samples from surgical SI colic horses compared to controls. However, no association with postoperative ileus or non-survival could be demonstrated at any time point. In this clinical study, plasma serotonin was not a suitable prognostic factor in horses with SI surgical colic.

Sérotonine plasmatique chez des chevaux subissant une chirurgie pour des coliques du petit intestin. Cette étude a comparé les concentrations de sérotonine dans le plasma faible en plaquettes (PFP) de chevaux en santé et de chevaux atteints de coliques chirurgicales du petit intestin et a évalué leur association avec l'occlusion intestinale postopératoire, la strangulation et la non-survie. Des échantillons de plasma (avec EDTA) ont été prélevés auprès de 33 chevaux atteints de coliques du petit intestin à plusieurs moments préopératoires et postopératoires. Les concentrations de sérotonine ont été déterminées à l'aide d'un spectromètre de masse LC-ESI-MS/MS. Les résultats ont été comparés avec ceux de 24 animaux témoins en santé. Les concentrations de sérotonine du PFP étaient significativement inférieures (P < 0,01) dans les échantillons préopératoires et postopératoires provenant des chevaux atteints de coliques du petit intestin comparativement aux animaux témoins. Cependant, aucune association avec l'occlusion intestinale postopératoire ou la non-survie n'a pu être démontrée à aucun moment. Dans cette étude clinique, la sérotonine plasmatique ne s'est pas avéré un facteur de pronostic approprié chez les chevaux atteints de coliques chirurgicales du petit intestin.(Traduit par Isabelle Vallières).

[State of homeostasis links in the children with intestinal colic].

The state of homeostasis links in the children with intestinal colic is represented by the following parameters and clinical characteristics. The data of investigated children's contingent with intestinal colic prevailed by following comorbidities: SARS--12 (18.18% ± 4.78%), protein-energy malnutrition--9 (12.85% ± 3.82%), pneumonia--6 (8.57% ± 3.57%), atopic dermatitis--7 (10.00% ±.3.57%). All children have a next complaints: flatulence (100%), in the 62 children (88.57% ± 3.82%) were identificated frequent regurgitation, in the 48 (80.33%)--hyperbilirubinemia. ALT levels were elevated in 25 children (41%) and 31 (51.66%) children had increased levels of AST. IL8 level were elevated in the 40 children (71.42%). The level of antibodies to elastase was greatly increased in all 56 (100%) children.

Progression of plasma D-dimer concentration and coagulopathies during hospitalization in horses with colic.

OBJECTIVE: To assess the progression of plasma D-dimer concentrations and coagulation status in horses with different types of colic. DESIGN: Prospective clinical observational study performed between March 2004 and September 2008. SETTING: Veterinary university teaching hospital. ANIMALS: Horses admitted and treated for colic and hospitalized for >48 hours were considered. Animals were classified by diagnosis into medical obstructive conditions (MO), surgical obstructive conditions (SO), inflammatory conditions, and ischemic lesions (IS). INTERVENTIONS: Three blood samples were obtained from each horse (admission, at 24-48 h [or after surgery] and upon discharge). For each sample, plasma D-dimer concentration, prothrombin time, activated partial thromboplastin time, antithrombin activity, and the presence of subclinical disseminated intravascular coagulation were determined. MEASUREMENTS AND MAIN RESULTS: When median plasma D-dimer concentration values at admission and after 24-48 hours were compared, they were different but stable in horses with MO (1.29-1.95 nmol/L) and inflammatory conditions (5.70-6.69 nmol/L). However, 10-fold and 5-fold increases were observed, respectively, in SO (2.08 to 16.38 nmol/L) and IS (3.08 to 15.91 nmol/L) in the postoperative period. By 24-48 hours, the percentage of horses with coagulopathy increased in most groups (MO, 43 to 58%; SO, 50 to 96%, IS, 53 to 90%). By the time of discharge, 87% of horses with SO problems and 89% of horses with IS still had some form of coagulopathy documented. CONCLUSIONS: Throughout hospitalization, horses with MO problems had less severe coagulopathy and lower plasmatic D-dimer concentrations compared to other groups of horses. On admission, most horses with inflammatory conditions presented with coagulopathy. At 24-48 hours of hospitalization and following surgery, the hemostatic profile can differ markedly when compared to admission values.

Serum cortisol concentrations in horses with colic.

Few studies have evaluated cortisol concentrations in horses with colic. In humans with septic shock, high cortisol levels are associated with an increased risk of death. The objectives of this study were to compare the serum total cortisol concentrations (STCCs) in horses with colic to those without colic, and to assess whether the STCC relates to the pathological nature or outcome of the disease. STCCs were determined at presentation in horses with colic and in systemically healthy 'control' horses. Horses with colic were grouped based on clinical and clinico-pathological parameters at admission, treatment, lesion type and location, and outcome. Univariable and multivariable logistic regression were performed using two different outcome measures: (a) whether the horse had colic or not (yes vs. no), and (b) horse STCC (≥200 nmol/L vs. <200 nmol/L). Horses were more likely to have colic if they presented with high STCCs (≥200 nmol/L compared with <200 nmol/L). Horses with colic and with STCCs ≥200nmol/L were more likely to have moderate or severe colic signs (compared with mild colic) and heart rates >45 beats per min (compared with ≤45 beats per min). It was concluded that colic in horses is associated with elevated STCCs, and increased STCC in horses with colic appears to relate to the severity of the disease. STCCs may provide additional decision-making and prognostic information in horses with colic but further studies are required to avoid misinterpretations associated with the wide variation in STCCs.

Cardiac troponin I concentrations in horses with colic.

OBJECTIVE: To determine prevalence of myocardial injury in horses with colic on the basis of high concentrations of cardiac troponin I (cTnI), frequency of cardiac arrhythmias within the first 24 to 48 hours after hospital admission or surgery because of colic, and associations between high cTnI concentrations and cardiac arrhythmias, clinical course, and outcome (survival to discharge from hospital vs nonsurvival [death or euthanasia]). DESIGN: Prospective observational study. ANIMALS: 111 horses with colic. PROCEDURES: Blood was drawn at admission and 12 and 24 hours after admission if horses were treated medically or 12 and 24 hours after surgery if treated surgically. A 24-hour ambulatory ECG was recorded beginning the morning after admission in medically treated cases or after surgery and evaluated for arrhythmias. Clinical and clinicopathologic data and outcome were obtained. Associations between cTnI concentrations and other variables were determined. RESULTS: An abnormal cTnI concentration (≥ 0.10 ng/mL) at admission was significantly associated with the occurrence of ventricular arrhythmias, outcome, and surgical treatment. CONCLUSIONS AND CLINICAL RELEVANCE: The data suggested that horses with colic and high cTnI concentrations at admission were more likely to have ventricular arrhythmias and have a less favorable prognosis for recovery. High cTnI concentrations in horses with colic were suggestive of myocardial damage.

Sensitivity and specificity of blood leukocyte counts as an indicator of mortality in horses after colic surgery.

The objectives of this study were to describe and relate perioperative changes in blood leukocyte counts to the outcome of surgical colic horses, determine a cut-off value in the early postoperative period to obtain an indicator of the outcome, and compare the obtained value to a validation population of horses. Fifty-three horses undergoing colic surgery were included in the descriptive part of the study. Total leukocyte counts were performed before, during and serially after surgery. A receiver operating characteristic analysis was performed on the leukocyte counts of 45 of these horses to determine a cut-off value for the outcome. The results obtained were validated on a second set of 50 horses that underwent colic surgery in similar conditions. The kinetics of blood leukocytes in survivors was higher than in non-survivors during the first days. Non-survivor horses were more likely to have at least one blood leukocyte count ≤ 3.9 × 10(3)/mm(3) between 28 and 60 hours after surgery than survivor horses. This cut-off value was confirmed in the validation population. These results suggest that routine values of blood leukocyte counts can be used as an additional prognostic indicator after colic surgery alongside other predictors previously associated with the outcome.

Serum amyloid A and haptoglobin concentrations in serum and peritoneal fluid of healthy horses and horses with acute abdominal pain.

BACKGROUND: Peritoneal fluid (PF) analysis is a valuable diagnostic tool in equine medicine. Markers such as serum amyloid A (SAA) and haptoglobin (Hp) could facilitate the diagnosis of inflammatory abdominal conditions. OBJECTIVES: The objectives were to (1) establish reference intervals (RI) for SAA and Hp in serum and PF in healthy horses, (2) compare SAA and Hp concentrations between healthy horses and horses with colic, and (3) to assess the correlation between serum and PF concentrations. METHODS: Serum amyloid A and Hp concentrations were determined by automated assays in prospectively enrolled healthy reference horses and horses with colic. RIs were calculated, group concentrations were compared by Student's t-test, and Pearson's correlation for serum and PF concentrations were determined. RESULTS: In healthy horses (n = 62) the measurements for SAA were below the detection limit (0.5 mg/L) in 94% of serum samples and 98% of PF samples. Horses with colic (n = 61) had statistically significantly increased SAA concentrations in serum (P < .0001) and PF (P = .0013). While PF Hp concentrations were increased in horses with colic the serum concentrations of Hp were decreased (P < .0001). There was a strong correlation between paired serum and PF SAA concentrations (n = 94, R = .72, P < .0001), whereas the correlation between paired serum and PF Hp was weak (n = 94, R = .22, P = .0382). Finally, horses with colic tended to have serum SAA and PF Hp concentrations above the RIs. CONCLUSIONS: With the apparent difference between healthy horses and horses with colic and the presently established RIs, serum SAA and PF Hp concentrations represent potential valuable diagnostic markers for inflammatory abdominal conditions in that species.

In equine grass sickness, serum amyloid A and fibrinogen are elevated, and can aid differential diagnosis from non-inflammatory causes of colic.

Equine grass sickness (EGS) is a debilitating and often fatal neurodegenerative disease. A presumptive diagnosis of EGS may be made on the basis of clinical signs and subjective ancillary tests, but a definitive antemortem diagnosis can only be made following histopathological examination of intestinal biopsies. It has previously been reported that horses with EGS may show clinical and clinicopathological signs of systemic inflammation. The objective of this study was to (a) quantify acute inflammatory markers in blood samples collected from acute, subacute and chronic EGS cases, and (b) compare them with (i) clinically normal horses co-grazing with acute EGS cases (co-grazers), (ii) horses with other causes of colic and (iii) healthy horses. Serum amyloid A (SAA), serum activin A and plasma fibrinogen were quantified. There were marked increases in SAA and fibrinogen in EGS cases compared with healthy horses, co-grazers and non-inflammatory colic cases. The concentrations of SAA and fibrinogen in EGS cases were not significantly different from inflammatory colic cases. When concentrations of SAA, fibrinogen and activin A in each EGS subgroup were compared, no significant differences were detected. Activin A concentrations were significantly elevated in EGS cases and co-grazing horses; this could reflect the presence of subclinical disease in some horses that do not develop clinical signs of EGS, and suggests widespread exposure to the aetiological agent. When faced with sparse antemortem diagnostic techniques, identification of marked increases in acute phase protein concentrations may help to differentiate EGS from other causes of abdominal pain, such as intestinal obstructions; however, there could be diagnostic difficulty in differentiating other inflammatory abdominal conditions, such as peritonitis or enteritis.

Interpreting lactate measurement in critically ill horses: diagnosis, treatment, and prognosis.

In hospitalized horses, hypovolemia and the resulting decrease in tissue perfusion is the most common cause of hyperlactatemia. Therefore, measurement of blood lactate concentration can be a useful tool for guiding fluid therapy. Similarly, measuring blood lactate concentration can be used to assess the need for and adequacy of transfusions in horses receiving whole blood. Inflammatory leukocytes within closed body cavities consume glucose and produce lactate. Simultaneous measurement of blood lactate concentration and lactate concentration of peritoneal, pleural, or synovial fluid has been used to help differentiate septic from nonseptic effusions. A fluid lactate concentration higher than the blood lactate concentration provides evidence for a bacterial cause of the effusion. In horses evaluated for colic, a peritoneal lactate concentration higher than the simultaneously measured blood lactate concentration is indicative of intestinal strangulation and ischemia. Veterinary studies have suggested that serial blood lactate measurements might be a more useful prognostic indicator than a single lactate measurement. In hospitalized adult horses and foals, blood lactate concentration is higher at all time points in nonsurvivors compared with survivors, although the differences tend to be subtle. Measuring the rate at which lactate concentrations return to normal might also prove useful in equine medicine, but this requires further investigation.