title: Prognostic value of clinicopathologic variables obtained at admission and effect of antiendotoxin plasma on survival in septic and critically ill foals.
abstract: This prospective study compared survival rates of critically ill and septic foals receiving 1 of 2 different types of commercial equine plasma and analyzed admission variables as possible predictors of survival. Standardized clinical, hematologic, biochemical, and hemostatic admission data were collected and foals received either conventional commercially available hyperimmune equine plasma or equine plasma specifically rich in antiendotoxin antibodies in a double-blinded, coded fashion. Sepsis was defined as true bacteremia or sepsis score >11. Overall survival rate to discharge was 72% (49/68). Foals that were nonbacteremic and demonstrated a sepsis score of < or = 11 at admission had a 95% (18/19) survival rate. The survival rate to discharge for septic foals was 28/49 (57%), with truly bacteremic foals having a survival rate of 58% (14/24), whereas that for nonbacteremic, septic foals was 56% (14/25). Sensitivity and specificity for sepsis score >11 as a predictor of bacteremia were 74 and 52%, respectively. For the entire study population, a higher survival rate to discharge was documented for those foals receiving hyperimmune plasma rich in antiendotoxin antibodies (P = .012, odds ratio [OR] 6.763, 95% confidence interval [CI]: 1.311, 34.903). Administration of plasma rich in antiendotoxin antibodies also was associated with greater survival in septic foals (P = .019, OR 6.267, 95% CI: 1.186, 33.109). Statistical analyses demonstrated that, among 53 clinical and clinicopathologic admission variables, high sepsis score (P < .001), low measured IgG concentration (P = .01), high fibrinogen concentration (P = .018), low segmented neutrophil count (P = .028), and low total red blood cell numbers (P = .048) were the most significant predictors of overall mortality.
authors.affiliation: Department of Medical Sciences, University of Wisconsin-Madison, School of Veterinary Medicine, WI 53706, USA. peeks@svm.vetmed.wisc.edu
authors.forename: Simon F
authors.initials: SF
authors.lastname: Peek
authors.forename: Sue
authors.initials: S
authors.lastname: Semrad
authors.forename: Sheila M
authors.initials: SM
authors.lastname: McGuirk
authors.forename: Ase
authors.initials: A
authors.lastname: Riseberg
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Slack
authors.forename: Fernando
authors.initials: F
authors.lastname: Marques
authors.forename: Dane
authors.initials: D
authors.lastname: Coombs
authors.forename: Laura
authors.initials: L
authors.lastname: Lien
authors.forename: Nicholas
authors.initials: N
authors.lastname: Keuler
authors.forename: Benjamin J
authors.initials: BJ
authors.lastname: Darien
mesh_terms: D000818:Animals; D000831:Animals, Newborn; D001774:Blood Chemical Analysis / Q000662:veterinary; D001803:Blood Transfusion / Q000662:veterinary; D016638:Critical Illness; D004311:Double-Blind Method; D004638:Emergency Treatment / Q000662:veterinary; D006734:Horse Diseases / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006736:Horses; D007074:Immunoglobulin G / Q000008:administration & dosage; D007136:Immunoglobulins / Q000008:administration & dosage; D010343:Patient Admission; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D018805:Sepsis / Q000175:diagnosis / Q000662:veterinary*; D012720:Severity of Illness Index; D016019:Survival Analysis; D014922:Wisconsin
chemical_list: D007074:Immunoglobulin G; D007136:Immunoglobulins; C042866:antilipopolysaccharide antibodies