Evaluation of quick sequential organ failure scores in dogs with severe sepsis and septic shock

Abstract

To evaluate the prognostic utility of the quick sequential organ failure assessment score in dogs with severe sepsis and septic shock presenting to an emergency service, and evaluate the clinical value of the quick sequential organ failure assessment score to predict severe sepsis and septic shock. Materials and MethOds:The quick sequential organ failure assessment score was calculated by evaluating respiratory rate (>22 breaths per minute), arterial systolic blood pressure (≤100 mmHg) and altered mentation. The quick sequential organ failure assessment scores with respiratory rate cut-offs of greater than 22, greater than 30 and greater than 40 were compared. Cases were defined as dogs presented to the emergency room and met at least 2 systemic inflammatory response syndrome criteria, had documented infection, and at least one organ dysfunction. A control population of dogs included animals with non-infectious systemic inflammatory response syndrome.results: Forty-five dogs with severe sepsis and septic shock and 45 dogs with non-infectious systemic inflammatory response syndrome were included in the final analysis. The quick sequential organ failure assessment provided poor discrimination between survivors and non-survivors for severe sepsis and septic shock (area under receiving operating characteristic curve, 0.51; 95% confidence interval, 0.35 to 0.67). Discrimination remained poor when quick sequential organ failure assessment greater than 30 and quick sequential organ failure assessment greater than 40 scores were calculated (area under receiving operating characteristic curve, 0.56; 95% confidence interval, 0.39 to 0.72, and 0.54; 95% confidence interval, 0.36 to 0.71). The quick sequential organ failure assessment of at least 2, quick sequential organ failure assessment greater than 30 of at least 2 and quick sequential organ failure assessment greater than 40 of at least 2 produced sensitivity and specificity to detect severe sepsis and septic shock of 66. 7% and 64.5%, 62.2% and 71.1%, 44.4% and 80%, respectively. cOnclusiOn and clinical significance: Scoring systems utilised in emergency rooms should have high sensitivity to reduce missed sepsis cases and treatment delays. The use of the quick sequential organ failure assessment for severe sepsis and septic shock demonstrated poor mortality prediction and low sensitivity to detect canine patients with severe sepsis and septic shock and should not be used alone when screening for sepsis.

Impact of a Dexmedetomidine Intravenous Infusion in Septic Dogs: Preliminary Study

“…The severity scores used may not reflect differences between groups, specifically with regards to sepsis. The qSOFA score for example, although associated with length of recovery and mortality in patients with sepsis undergoing pyometra [ 33 ], has been shown to be a poor predictor of mortality and has low sensitivity in identifying canine patients with severe sepsis and septic shock [ 34 ]. Although there did not appear to be a significant difference between groups regarding the severity of injury based on the SOFA, qSOFA, and SI, it is possible that a difference in management between the two groups could have contributed to a difference in the intra-operative requirements of vasopressors and overall mortality.…”

Case report: Sepsis secondary to infected protracted parotid sialocele after maxillofacial oncologic surgery in a dog

“…Sepsis is broadly defined as a systemic inflammatory response to infection (4)(5)(6)(7). This clinically manifests as two or more of the following: (1) change in temperature (hyper or (4).…”

“…When cardiovascular instability and profound metabolic/cellular abnormalities are superimposed on sepsis, it is termed septic shock, which carries a higher mortality risk than sepsis alone. In companion animals, infection from the gastrointestinal tract is the most common source of sepsis and septic shock (4)(5)(6).…”