title: Associations among albuminuria, C-reactive protein concentrations, survival predictor index scores, and survival in 78 critically ill dogs.
abstract: BACKGROUND
  Microalbuminuria and C-reactive protein (CRP) are predictors of morbidity and survival in critically ill human patients.
  
  
  OBJECTIVE
  To evaluate results of microalbuminuria assays (untimed single-sample urine albumin concentration [U-ALB] and the urine albumin:creatinine ratio [UACR]), serum CRP, and survival predictor index (SPI2) scores as predictors of survival in critically ill dogs.
  
  
  METHODS
  Seventy-eight dogs admitted to intensive care units at University of Tennessee (UT) and Colorado State University (CSU).
  
  
  METHODS
  Prospective observational study. Critically ill dogs were eligible for enrollment, unless euthanized because of financial constraints. Samples were collected within 3 hours of admission. Spearman's rank-correlation coefficients were determined for U-ALB, UACR, CRP, and SPI2. U-ALB, UACR, CRP, and SPI2 were assessed for associations with 7- and 30-day survival by Mann-Whitney U-tests and receiver operating characteristic (ROC) curves. P-values < .0125 were considered significant.
  
  
  RESULTS
  UT (n = 49) and CSU (n = 29) patients did not differ significantly. Forty percent (31/78) of dogs died. SPI2 was inversely correlated with U-ALB (r(s) = -0.39, P < .001) and UACR (r(s) = -0.41, P < .001). CRP was not correlated with SPI2 (P = .019), U-ALB (P > .1), or UACR (P > .1). U-ALB and UACR had very high correlation (r(s) = 0.95, P < .001). SPI2, U-ALB, and UACR differed significantly for survivors and nonsurvivors. SPI2, U-ALB, and UACR had areas under the ROC curve (AUC) from 0.68 to 0.74 for survival prediction.
  
  
  CONCLUSIONS
  Albuminuria and SPI2, but not CRP, are associated with survival in critically ill dogs. Suboptimal AUCs limit the value of microalbuminuria testing for clinical risk assessment. Additional studies are necessary to determine the usefulness of microalbuminuria testing in patient risk stratification for prospective research.
authors.affiliation: Department of Small Animal Clinical Sciences, the College of Veterinary Medicine, University of Tennessee, Knoxville, TN 37996-4550, USA. jwhittemore@utk.edu
authors.forename: J C
authors.initials: JC
authors.lastname: Whittemore
authors.forename: B A
authors.initials: BA
authors.lastname: Marcum
authors.forename: D I
authors.initials: DI
authors.lastname: Mawby
authors.forename: M V
authors.initials: MV
authors.lastname: Coleman
authors.forename: T B
authors.initials: TB
authors.lastname: Hacket
authors.forename: M R
authors.initials: MR
authors.lastname: Lappin
mesh_terms: D000419:Albuminuria / Q000378:metabolism*; D000818:Animals; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis / Q000378:metabolism*; D016638:Critical Illness; D004283:Dog Diseases / Q000097:blood* / Q000652:urine; D004285:Dogs; D011446:Prospective Studies; D012372:ROC Curve; D016019:Survival Analysis
chemical_list: D002097:C-Reactive Protein