Acute phase proteins as diagnostic markers in horses with colic

TY - JOUR

T1 - Acute phase proteins as diagnostic markers in horses with colic

AU - Pihl, Tina

AU - Scheepers, Elrien

AU - Sanz, Macarena

AU - Goddard, Amelia

AU - Page, Patrick

AU - Toft, Nils

AU - Kjelgaard-Hansen, Mads

AU - Andersen, Pia Haubro

AU - Jacobsen, Stine

PY - 2016/9/1

Y1 - 2016/9/1

N2 - OBJECTIVE: To investigate the diagnostic potential of the concentrations of acute-phase proteins serum amyloid A (SAA), haptoglobin (Hp), and fibrinogen in blood and peritoneal fluid (PF) for differentiating horses with inflammatory colic (entero-colitis and peritonitis) from those with surgical colic.DESIGN: Prospective observational multicenter study.SETTING: Two university referral hospitals.ANIMALS: Horses referred for severe acute abdominal pain to Hospital 1 (n = 148) or Hospital 2 (n = 78).INTERVENTION: Blood and PF samples collected at admission were used for acute-phase protein concentration measurement.MEASUREMENTS AND MAIN RESULTS: A multivariable logistic model including clinical parameters (lethargy, rectal temperature >38°C [100.4°F], normal rectal examination findings, and gastric reflux of 5-10 L) recorded at admission was constructed from Hospital 1 data. The ability of the model to correctly differentiate inflammatory from surgical colic was 86% determined as area under the receiver operating characteristic curve. Adding blood parameters (WBC, PCV, total plasma protein, lactate, SAA, Hp, and fibrinogen concentrations) to the logistic model based on clinical parameters revealed that only WBC and SAA and fibrinogen concentrations improved the model. With SAA included in the model no additional blood parameters improved the model, and the final model had an area under the curve of 90%. Addition of PF parameters (hemolysis, total protein concentration, WBC, SAA, or Hp concentrations) did not improve the model. When validated in Hospital 2 data, the models had good integrity and diagnostic performance.CONCLUSIONS: Evaluation of SAA in serum improved the ability to differentiate horses with acute inflammatory colic requiring medical treatment from horses with colic requiring surgery, as it allowed an additional 4% of horses to be correctly classified into medical and surgical cases. Improved differentiation of these 2 groups of horses with colic may minimize the risk of unnecessary or delayed surgery.

AB - OBJECTIVE: To investigate the diagnostic potential of the concentrations of acute-phase proteins serum amyloid A (SAA), haptoglobin (Hp), and fibrinogen in blood and peritoneal fluid (PF) for differentiating horses with inflammatory colic (entero-colitis and peritonitis) from those with surgical colic.DESIGN: Prospective observational multicenter study.SETTING: Two university referral hospitals.ANIMALS: Horses referred for severe acute abdominal pain to Hospital 1 (n = 148) or Hospital 2 (n = 78).INTERVENTION: Blood and PF samples collected at admission were used for acute-phase protein concentration measurement.MEASUREMENTS AND MAIN RESULTS: A multivariable logistic model including clinical parameters (lethargy, rectal temperature >38°C [100.4°F], normal rectal examination findings, and gastric reflux of 5-10 L) recorded at admission was constructed from Hospital 1 data. The ability of the model to correctly differentiate inflammatory from surgical colic was 86% determined as area under the receiver operating characteristic curve. Adding blood parameters (WBC, PCV, total plasma protein, lactate, SAA, Hp, and fibrinogen concentrations) to the logistic model based on clinical parameters revealed that only WBC and SAA and fibrinogen concentrations improved the model. With SAA included in the model no additional blood parameters improved the model, and the final model had an area under the curve of 90%. Addition of PF parameters (hemolysis, total protein concentration, WBC, SAA, or Hp concentrations) did not improve the model. When validated in Hospital 2 data, the models had good integrity and diagnostic performance.CONCLUSIONS: Evaluation of SAA in serum improved the ability to differentiate horses with acute inflammatory colic requiring medical treatment from horses with colic requiring surgery, as it allowed an additional 4% of horses to be correctly classified into medical and surgical cases. Improved differentiation of these 2 groups of horses with colic may minimize the risk of unnecessary or delayed surgery.

KW - Faculty of Health and Medical Sciences

KW - Acute phase proteins

KW - surgery

KW - diagnostic accuracy

KW - horse

KW - colic

KW - white blood cell count

KW - lactate

KW - peritoneal fluid

KW - fibrinogen

KW - haptoglobin

KW - serum amyloid A

U2 - 10.1111/vec.12504

DO - 10.1111/vec.12504

M3 - Journal article

C2 - 27384962

SN - 1479-3261

VL - 26

SP - 664

EP - 674

JO - Journal of Veterinary Emergency and Critical Care

JF - Journal of Veterinary Emergency and Critical Care

IS - 5

ER -