Establishing a sepsis-score for adult equine patients. (Bernhard Huskamp Kolik-Symposium, Berlin, Germany, 7-10 June, 2012) [German]

摘要

Septicaemia is a serious and often fatal condition. For a prompt diagnosis, objective assessment of the grade and progression of septicaemia and the fast initiation or modification of possibly required intensive care, it is recommended to use a scoring system for patients with suspected sepsis. A sepsis scoring system exists for human patients and for several animal species, but in equines only for neonates. Therefore, this study implies to develop a scoring system for adult equine patients and to evaluate it by means of patient data. Eleven clinical (behaviour, heart rate, respiratory rate, temperature, petechiation, diarrhoea, dyspnoea, wounds, pulsation of the palmar medial and lateral digital arteries, colour of mucous membranes and evidence of an infection) and five laboratory parameters (white blood cell count, immature forms of neutrophils, thrombocyte count, calcium and fibrinogen) were included. These data are easy to determine by a practitioner. By assigning between zero and three points per parameter, a maximum of 42 points is possible. First, this system was tested on 30 equine patients with proven septicaemia (septicaemia group) and 30 equine patients with no septicaemia (control group). Regarding to the median values of these groups, the confidence interval and the receiver-operating-characteristic-curve, categories were assigned based on the determined points: >13 points=positive, 10-12 points=questionable, <10 points=negative. With a sensitivity of 0.96 and a specificity of 1.0 the result is more than satisfying. In adult horse patients, septicaemia is most frequently caused by a disease of the gastrointestinal tract. Therefore, the sepsis scoring system was tested on 1836 colic patients with eight different diagnoses (spasmodic colic, equine gastric ulcer syndrome (EGUS), impaction of the caecum or large colon, displacement of the large colon, strangulating obstruction of the small intestine, strangulating obstruction of the large intestine, acute colitis or thrombo-embolic colic). As expected, the highest sepsis scores occurred in patients with acute colitis (median value=10) and thrombo-embolic colic (median value=7). Low values were obtained in horses with spasmodic colic, EGUS and caecum or colon impactions (median value=3). The sepsis scoring system is easy to use and provides a fast and safe assessment of adult equine patients without a time-consuming and cost-intensive blood culture. This is especially important in horses with colic for the determination of a prognosis and the necessity of intensive care including antibiotic therapy. If surgery is recommended, it is easier to estimate the prognosis and anaesthetic risk and to make a decision towards or against surgery. If the result is questionable, observation of the clinical course is recommended. Probably, the score is going to improve or worsen within a few hours after the initiation of treatment.