Assessment of hemostasis in dogs with gastric-dilation-volvulus, during resuscitation with hydroxyethyl starch (130/0.4) or hypertonic saline (7.5%).

OBJECTIVE: To compare the impact of an IV bolus of hydroxyethyl starch 130/0.4 (HES) or hypertonic saline 7.5% (HS) on hemostasis in dogs resuscitated for gastric-dilation-volvulus (GDV). DESIGN: Open-label, parallel-group randomized clinical trial. ANIMALS: Twenty-three client-owned dogs. INTERVENTIONS: Dogs affected by GDV and shock were randomly assigned to receive HES at 10 mL/kg or HS at 4 mL/kg every 15 minutes. Blood samples were collected for blood gas analysis, PCV, total plasma protein, albumin, standard coagulation profile, and thromboelastometry (ROTEM) at baseline (T0) and at the end of bolus (T1). To assess the differences between the 2 groups at T1, Student's t-test or Wilcoxon rank-sum test was used. To evaluate the differences between T0 and T1, ANOVA for paired data or Wilcoxon matched-pairs signed-ranks test was used. P < 0.05 was considered significant. MEASUREMENT AND MAIN RESULTS: Hemostasis was evaluated by means of prothrombin time, activated partial thromboplastin time, fibrinogen, and ROTEM. The study included 13 dogs in the HES group and 10 dogs in the HS group. Differences were found between groups at T1: increase in clotting time (P = 0.018) and decrease in fibrinogen level (P = 0.021) in the HS-treated group. Between T0 and T1, there were differences for the HES group: increase in clot formation time (P = 0.046), decrease in maximum clot firmness (P = 0.002) in ex-TEM profile, and decrease in maximum clot firmness (P = 0.0117) in fib-TEM profile. Between T0 and T1, the following differences were noted for the HS group: increase in clotting time (P = 0.048) and clot formation time (P = 0.0019), decrease in maximum clot firmness (P = 0.031) and α angle (P = 0.036) in ex-TEM profile, decrease in α angle (P = 0.036) in in-TEM profile, and decrease in maximum clot firmness (P = 0.017) in fib-TEM profile. CONCLUSION: In dogs affected by GDV, HES or HS infusion caused a similar tendency toward hypocoagulability, with few differences between the 2 groups.

Multiorgan dysfunction syndrome in feline sepsis: prevalence and prognostic implication.

OBJECTIVES: The current study was designed to evaluate the prevalence and prognostic significance of multiorgan dysfunction syndrome (MODS) in cats with sepsis. METHODS: Cats hospitalised in the intensive care unit of a veterinary university hospital with a diagnosis of sepsis were prospectively enrolled and divided according to disease severity and outcome (survivors; non-survivors). The feline acute patient physiological and laboratory evaluation (APPLE) scores were calculated upon admission, as previously described. Specific criteria to identify selected organ dysfunction (hepatic, renal, respiratory, cardiocirculatory, haemostatic) were adapted from the available human and veterinary literature, and evaluated at baseline and at the end of hospital stay. MODS was defined as the presence of at least two dysfunctional organs simultaneously. Non-parametric statistics were used for comparisons. Univariate and multivariate regression analyses to evaluate significant risk factors for death were carried out. Correlations between variables were assessed by the Spearman's rank correlation coefficient. Significance was set at P <0.05. RESULTS: A total of 43 cats with heterogeneous sources of sepsis were included. MODS was identified in 25/43 cats upon admission and in 32/43 cats at the end of hospital stay. Regression analyses showed a significantly elevated odds ratio for mortality for the presence of MODS, renal and cardiovascular dysfunction upon admission, as well as for the number of dysfunctional organs. The latter was the only variable retained by the model from the multivariate binary logistic regression analysis. Significant correlations were documented between the number of dysfunctional organs and the APPLE scores. CONCLUSIONS AND RELEVANCE: MODS is a frequent complication of feline sepsis, and is associated with worse outcomes. In particular, renal and cardiovascular dysfunction significantly increase the odds for death. Hence, systematic screening for organ dysfunction is advocated in cats with sepsis.

Cell-Free DNA, High-Mobility Group Box-1, and Procalcitonin Concentrations in Dogs With Gastric Dilatation-Volvulus Syndrome.

Canine gastric dilatation-volvulus (GDV) is a life-threatening disease characterized by extensive tissue ischemia, tissue hypoperfusion, and systemic inflammation. Biomarkers that better reflect the severity of gastric necrosis and systemic inflammation would aid clinicians in the management of these patients. This study aimed to investigate the prognostic significance of cell-free DNA (cfDNA), high-mobility group box-1 (HMGB1), and procalcitonin (PCT) in dogs with GDV. Concentrations of cfDNA, HMGB1, and PCT were measured in citrated plasma samples collected from 29 dogs with GDV at hospital admission. Additional data collected included baseline lactate concentrations, APPLEfast score, evidence of gastric necrosis, occurrence of postoperative complications, and outcome. Twenty-four healthy dogs were sampled as controls. Continuous variables between groups were compared with the Mann-Whitney U and correlations between continuous variables were assessed by calculation of Spearman's correlation coefficient. Alpha was set at 0.05. Dogs with GDV had significantly greater concentrations of cfDNA, HMGB1, and PCT compared to controls (P = 0.0009, P = 0.004, and P = 0.009, respectively). PCT concentrations were significantly higher in non-survivors compared to survivors (P = 0.008). Dogs with gastric necrosis had significantly greater lactate concentrations compared to dogs without gastric necrosis (P = 0.0005). The APPLEfast score was not prognostic. Lactate and PCT concentrations were moderately, positively correlated (rs 0.51, P = 0.0005). Concentrations of the inflammatory biomarkers cfDNA, HMGB1, and PCT are increased in canine GDV. Only lactate and PCT concentrations were prognostic in this population of GDV dogs and were predictive of the presence of gastric necrosis and of non-survival to hospital discharge, respectively.