Prognostic Value and Development of a Scoring System in Horses With Systemic Inflammatory Response Syndrome

Abstract

BackgroundDespite its widespread use in equine medicine, the clinical value of the systemic inflammatory response syndrome (SIRS) concept in horses remains unknown.ObjectivesTo study the prognostic value of measures of SIRS in horses and identify the best model of severe SIRS to predict outcome.AnimalsA total of 479 consecutive adult horse emergency admissions to a private primary referral practice.MethodsProspective observational study. All adult horses admitted for emergency treatment over the study period were included. Multivariate logistic regression and stepwise model selection were used.ResultsEach of the 4 SIRS criteria was associated with outcome in this population. Thirty‐one percent of emergency cases had 2 or more abnormal SIRS criteria on admission and were defined as SIRS cases. SIRS was associated with increased odds of death (odds ratio [OR] = 8.22; 95% CI, 4.61–15.18; P < .001), an effect mainly found for acute gastrointestinal cases. SIRS cases were assigned a SIRS score of 2, 3, or 4, according to the number of abnormal SIRS criteria fulfilled on admission, and SIRS3 and SIRS4 cases had increased odds of death compared to SIRS2 cases (OR = 4.45; 95% CI, 1.78–11.15; P = .002). A model of severe SIRS including the SIRS score, blood lactate concentration, and color of the mucous membranes best predicted outcome in this population of horses.Conclusions and Clinical ImportanceSystemic inflammatory response syndrome is associated with an increased risk of death in adult horses presenting with acute gastrointestinal illnesses. The model of severe SIRS proposed in this study could be used to assess the status and prognosis of adult equine emergency admissions.

Paraoxonase‐1 activity evaluation as a diagnostic and prognostic marker in horses and foals

“…The following data were recorded in order to classify and divide the sick horses in SIRS‐positive or SIRS‐negative groups: presence of abnormal leukocyte count as leukopenia or leukocytosis (reference interval [RI], 5.0‐12.5 × 10 3 /μL), left shift (RI, >10% band neutrophils), hyperthermia or hypothermia (RI, 37.0°C‐38.5°C), tachycardia (RI, >52 beats per minute [bpm]), and tachypnea (RI, >20 breaths per minute). Horses with 0 or 1 abnormal criterion were included in the SIRS‐negative group, whereas horses with ≥2 abnormal criteria were included in the SIRS‐positive group …”

“…Horses with 0 or 1 abnormal criterion were included in the SIRS-negative group, whereas horses with ≥2 abnormal criteria were included in the SIRS-positive group. 16 Retrospectively, sick horses also were divided into survivors and non-survivors. Animals were considered survivors if they were discharged from the hospital, whereas they were considered nonsurvivors if they died or were humanely euthanized because of severe medical prognosis rather than for economic reasons.…”

“…Our aim was to compare PON‐1 activity in sick horses classified as SIRS‐positive or SIRS‐negative, as proposed by others, and to investigate the performances of PON‐1 activity in terms of sensitivity, specificity, and likelihood ratio in identifying SIRS‐positive and negative horses. Finally, the possible prognostic role of PON‐1 activity was assessed by evaluating PON‐1 activity in sick horses based on clinical outcome.…”

“…13 An early diagnosis should be the goal in management of SIRS patients, allowing starting adequate treatment in an early stage. 14,15 Our aim was to compare PON-1 activity in sick horses classified as SIRS-positive or SIRS-negative, as proposed by others, 16 and to investigate the performances of PON-1 activity in terms of sensitivity, specificity, and likelihood ratio in identifying SIRS-positive and negative horses.…”

Highlights of recent clinically relevant papers

“…The objectives of this study by M.‐F. Roy and colleagues in Canada were to study the prognostic value of measures of systemic inflammatory response syndrome (SIRS) in horses and to identify the best model of severe SIRS to predict outcome .…”