Presence of Systemic Inflammatory Response Syndrome Predicts a Poor Clinical Outcome in Dogs with a Primary Hepatitis

Abstract

Primary hepatopathies are a common cause of morbidity and mortality in dogs. The underlying aetiology of most cases of canine hepatitis is unknown. Consequently, treatments are typically palliative and it is difficult to provide accurate prognostic information to owners. In human hepatology there is accumulating data which indicates that the presence of systemic inflammatory response syndrome (SIRS) is a common and debilitating event in patients with liver diseases. For example, the presence of SIRS has been linked to the development of complications such as hepatic encephalopathy (HE) and is associated with a poor clinical outcome in humans with liver diseases. In contrast, the relationship between SIRS and clinical outcome in dogs with a primary hepatitis is unknown. Seventy dogs with histologically confirmed primary hepatitis were enrolled into the study. Additional clinical and clinicopathological information including respiratory rate, heart rate, temperature, white blood cell count, sodium, potassium, sex, presence of ascites, HE score, alanine aminotransferase (ALT), alkaline phosphatase (ALP), bilirubin and red blood cell concentration were available in all cases. The median survival of dogs with a SIRS score of 0 or 1 (SIRS low) was 231 days compared to a median survival of 7 days for dogs with a SIRS score of 2, 3 or 4 (SIRS high) (p<0.001). A Cox proportional hazard model, which included all other co-variables, revealed that a SIRS high score was an independent predictor of a poor clinical outcome. The effect of modulating inflammation on treatment outcomes in dogs with a primary hepatitis is deserving of further study.

ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs

“…Details on serum liver enzyme activities from 27 retrospective studies of 848 dogs show increased serum ALT activity as the earliest indicator of CH (Table ) . Serum ALT activity thus is the best screening test for CH.…”

“…Several studies have examined prognostic factors in CH and these are summarized in Supporting Information Table S4 . Clinicopathologic factors with the strongest association with poor prognosis are hyperbilirubinemia, prolongations in PT and aPTT, and hypoalbuminemia.…”

“…6 (Table 9). 7,12,15,20,25,32,39,156,157,159,163,168,170,[175][176][177][178][179][180]183,184,186,[188][189][190][191][192][193][194] Serum ALT activity thus is the best screening test for CH. However, histopathologic evidence of CH can exist in the absence of increased serum liver enzyme activity.…”

“…27,178 Several studies have examined prognostic factors in CH and these are summarized in Supporting Information Table S4. 27,157,162,168,175,176,188 Clinicopathologic factors with the strongest association with poor prognosis are hyperbilirubinemia, prolongations in PT and aPTT, and hypoalbuminemia. Two studies, however, found no association between hyperbilirubinemia or low serum albumin concentrations and survival.…”

In vitro anti‐LPS dose determination of ketorolac tromethamine and in vivo safety of repeated dosing in healthy horses

“…Systemic inflammatory response syndrome (SIRS) is defined as widespread and exaggerated inflammation that can be triggered by infectious or noninfectious stimuli (Lewis, Chan, Pinheiro, Armitage‐Chan, & Garden, ; Moore & Vandenplas, ; Palmer, ; Roy, ). Possible complications of SIRS include coagulopathies and organ dysfunction, which can lead to death (Kelmer, ; Kilpatrick et al., ; Roy, ). Nonsteroidal anti‐inflammatory drugs (NSAIDs) are commonly administered to horses with SIRS to reduce eicosanoid production through inhibition of cyclooxygenase (COX) enzymes.…”