Introduction

According to the novel Sepsis-3 definition in humans, sepsis is the life-threatening organ dysfunction (OD) caused by a dysregulated host response to infection. OD is associated with a negative outcome in critically ill dogs. The aim of this study was to investigate the value of new-onset OD for the prediction of sepsis and outcome in dogs with systemic inflammation.

Methods

Critically-ill dogs with systemic inflammation (based on serum C-reactive protein >1.6 mg/dL) were retrospectively included. Sepsis was confirmed by cytology, microbiology, or molecular techniques. The following newly diagnosed OD on admission to ICU were registered: acute kidney injury (AKI, IRIS guidelines), hyperbilirubinemia (total bilirubin >0.4 mg/dL), coagulation abnormalities (prothrombin time [PT] >9 sec or activated partial thromboplastin time [aPTT] >16 sec or platelet count <150.000/mm³), hyperlactatemia, hypoxemia, presence of stupor/coma, fluid-refractory hypotension, and unexplained acidemia. Multiorgan dysfunction syndrome (MODS), as previously reported, and outcome at hospital discharge were also recorded. Non-parametric statistics were performed, and significance was set at P<0.05.

Results

A total of 275 dogs were enrolled: 147/275 (53%) had non-infectious systemic inflammation, 128/275 (47%) had sepsis. Only the presence of fluid-refractory hypotension was significantly associated with a diagnosis of sepsis (OR 10.51, CI 3.08–35.94; P<0.0001). According to univariate logistic regression, MODS (OR 2.58, CI 1.53–4.34; P=0.0003), AKI (OR 4.15, CI 2.44–7.04; P<0.0001), stupor/coma (OR 5.65, CI 1.95–16.38; P=0.0006), hyperbilirubinemia (OR 2.01, CI 1.14–3.53; P=0.0158), increased blood lactate (OR 1.22, CI 1.09–1.38; P=0.0006), fluid-refractory hypotension (OR 5.12, CI 2.13–12.29; P=0.0001), prolonged PT (OR 1.26, CI 1.07–1.49; P=0.0014), and decreased base excess (BE) (OR 0.89, CI 0.84–0.93; P<0.0001) were associated with non-survival. AKI (OR 3.97, CI 1.71–9.24; P=0.0014), stupor/coma (OR 8.43, CI 1.33–53.25; P=0.0234), PT (OR 1.20, CI 1.00–1.44; P=0.0437) and BE (OR 0.93, CI 0.87–0.99; P=0.0472) were the only variables retained in the multivariate model.

Conclusions

In our population of critically ill dogs, only fluid-refractory hypotension was associated with a diagnosis of sepsis. However, ODs were independently associated with outcome, with AKI, stupor/coma, prolonged PT and decreased BE being associated with higher risk of non-survival. Finally, screening of OD in critically ill dogs with systemic inflammation is warranted.

E-mail: elena.ciuffoli@gmail.com