Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates

Abstract

BackgroundThe original equine sepsis score provided a method of identifying foals with sepsis. New variables associated with sepsis have been evaluated, but the sepsis score has not been updated.ObjectivesTo evaluate the sensitivity and specificity of 2 updated sepsis scores and the systemic inflammatory response syndrome (SIRS) criteria in regard to detecting sepsis in foals.AnimalsTwo‐hundred and seventy‐three ill foals and 25 healthy control foals.MethodsHistorical, physical examination, and clinicopathologic findings were used to calculate the original sepsis score and 2 updated sepsis scores. SIRS criteria were also evaluated. Sepsis scores and positive SIRS scores were statistically compared to foals with sepsis.ResultsOne‐hundred and twenty‐six foals were septic and 147 sick‐nonseptic. The original and updated sepsis scores were significantly higher in septic foals as compared to sick‐nonseptic and healthy foals. The sensitivity and specificity of the updated sepsis scores to predict sepsis were not significantly better than those of the original sepsis score. One‐hundred and twenty‐seven of 273 (46.5%) foals met the original SIRS criteria and 88/273 (32%) foals met the equine neonatal SIRS criteria. The original SIRS criteria had similar sensitivity and specificity for predicting sepsis as did the 3 sepsis scores in our study.Conclusions and Clinical ImportanceThe updated sepsis scores did not provide improved ability in predicting sepsis. Fulfilling the original SIRS criteria provided similar sensitivity and specificity in predicting sepsis as the modified sepsis score and might serve as a diagnostic aid in identifying foals at risk for sepsis.

Plasma iron concentrations and systemic inflammatory response syndrome in neonatal foals

“…Forty‐seven ill neonatal foals were divided in 2 groups: SIRS (n = 24) and non‐SIRS (n = 23). The SIRS group was defined as meeting 2 or more of: (1) hyper‐ or hypo‐thermia (rectal temperature >39.2°C or <37.2°C), (2) leukocytosis or leukopenia (peripheral white blood cell count >12.5 × 10 3 /μL or <4 × 10 3 /μL) or >10% immature (“band”) neutrophils, (3) tachycardia (>120 beats/min), and (4) tachypnea (>30 breaths/min) 3,5‐8 …”

“…A positive result to the original SIRS criteria has a sensitivity of 60% and specificity of 69% to predict sepsis when compared to other proposed SIRS criteria 3,9,10 and could be more useful for predicting nonsurvival associated with sepsis 3 . Based on the human pediatric literature, an updated SIRS score for foals was proposed but it does not provide an improved ability in predicting sepsis 3,11 . SIRS criteria for foals of the aforementioned study required the presence of at least 3 of: (1) fever or hypothermia, (2) tachycardia, (3) tachypnea, (4) leukocytosis, leukopenia, >5% band neutrophils, (5) venous blood lactate concentration, or (6) venous blood glucose concentration; at least one of which had to be abnormal temperature or leukocyte count 9 …”

“…Early detection of systemic inflammation is essential in order to provide appropriate treatment 2 . The original systemic inflammatory response syndrome (SIRS) criteria in neonatal foals have a significant association with prediction of sepsis and nonsurvival 3 …”

“…Systemic inflammatory response syndrome describes the clinicopathologic effects of the inflammatory response to a variety of insults, including bacterial infection, endotoxemia, ischemia, hypoxia, trauma, and burns 5 . The original SIRS criteria used to describe this clinical syndrome in neonatal foals included presence of 2 or more of: (1) hyper‐ or hypo‐thermia (rectal temperature >39.2°C or <37.2°C); (2) leukocytosis or leukopenia (peripheral white blood cell count >12.5 × 10 3 /μL or <4 × 10 3 /μL) or > 10% immature (“band”) neutrophils; (3) tachycardia (>120 beats/min); and (4) tachypnoea (> 30 breaths/min) 3,5‐8 . The SIRS criteria is much simpler and faster to use than sepsis scores and might serve as a more rapid screening tool for sepsis in neonatal foals.…”

Highlights of recent clinically relevant papers

“…In this study, D.M . Wong and colleagues in the USA evaluated updated sepsis scoring systems and systemic inflammatory response syndrome (SIRS) criteria and their association with sepsis in equine neonates .…”