Equine neuroaxonal dystrophy/degenerative myeloencephalopathy in Gypsy Vanner horses.

BACKGROUND: Equine neuroaxonal dystrophy/degenerative myeloencephalopathy (eNAD/EDM) is a neurodegenerative disease that primarily affects young, genetically predisposed horses that are deficient in vitamin E. Equine NAD/EDM has not previously been documented in Gypsy Vanner horses (GVs). OBJECTIVES: To evaluate: (1) the clinical phenotype, blood vitamin E concentrations before and after supplementation and pedigree in a cohort of GV horses with a high prevalence of neurologic disease suspicious for eNAD/EDM and (2) to confirm eNAD/EDM in GVs through postmortem evaluation. ANIMALS: Twenty-six GVs from 1 farm in California and 2 cases from the Midwestern U.S. METHODS: Prospective observational study on Californian horses; all 26 GVs underwent neurologic examination. Pre-supplementation blood vitamin E concentration was assessed in 17- GVs. Twenty-three were supplemented orally with 10 IU/kg of liquid RRR-alpha-tocopherol once daily for 28 days. Vitamin E concentration was measured in 23 GVs after supplementation, of which 15 (65%) had pre-supplementation measurements. Two clinically affected GVs from California and the 2 Midwestern cases had necropsy confirmation of eNAD/EDM. RESULTS: Pre-supplementation blood vitamin E concentration was ≤2.0 µg/mL in 16/17 (94%) of GVs from California. Post-supplementation concentration varied, with a median of 3.39 µg/mL (range, 1.23-13.87 µg/mL), but only 12/23 (52%) were normal (≥3.0 µg/mL). Normalization of vitamin E was significantly associated with increasing age (P = .02). Euthanized horses (n = 4) had eNAD/EDM confirmed at necropsy. CONCLUSIONS AND CLINICAL IMPORTANCE: GVs could have a genetic predisposition to eNAD/EDM. Vitamin E supplementation should be considered and monitored in young GVs.

Prognostic indicators for survival of downer cattle treated using a flotation tank in a referral hospital: 190 cases (2000-2020).

BACKGROUND: Nonambulatory cattle present therapeutic challenges in addition to animal welfare concerns. Flotation therapy is a treatment option, but more information regarding prognostic indicators for survival is needed to guide use of this modality. HYPOTHESIS/OBJECTIVES: Evaluate historical and clinical variables assessed during hospitalization as prognostic indicators for survival in recumbent cattle undergoing flotation treatment in a referral hospital. ANIMALS: A total of 190 nonambulatory dairy cattle. METHODS: Retrospective case series. Medical records were analyzed from cattle undergoing flotation between 2000 and 2020. Univariable and multivariable logistic regression analyses were performed to assess the association of clinical variables with survival to discharge. RESULTS: Eighty-nine of 190 (47%) recumbent cattle survived to discharge. For each additional day of hospitalization, cattle were 1.10 (95% confidence interval [CI], 1.02, 1.21) times more likely to survive. Cattle unable to walk out of the tank after their first float session were 0.11 (95% CI, 0.04, 0.28) times less likely to survive compared to cattle that could and inappetent cattle were 0.22 (95% CI, 0.07, 0.63) times less likely to survive compared to cattle with normal appetites. Cattle diagnosed with coxofemoral luxation or toxemia were 0.11 (95% CI, 0.02, 0.65) and 0.16 (95% CI, 0.02, 0.90) times less likely to survive, respectively, compared to cattle with causes of recumbency that were undetermined. CONCLUSIONS AND CLINICAL IMPORTANCE: Walking out of the tank after the first float session, appetite, diagnosis, and days of hospitalization are associated with outcome in nonambulatory dairy cattle treated by flotation. These findings can be used to determine likely outcome and guide treatment, referral, or euthanasia decisions.

Resolution of tracheal collapse and stenosis without surgical intervention in two Holstein calves.

CASE DESCRIPTION: A 4-month-old 127.5-kg (280.5-lb) Holstein heifer calf (patient 1) and a 4-month-old 174-kg (382.8-lb) Holstein bull calf (patient 2) of high genetic value were examined because of signs of respiratory tract disease (dyspnea, wheezing, and coughing) of 2 and 3 months' duration, respectively, that did not respond to antimicrobial and anti-inflammatory treatment. Patient 1 was born with assistance owing to malpresentation and dystocia. The birth of patient 2 was unobserved. CLINICAL FINDINGS: For both calves, results of a physical examination, CBC, serum biochemical analysis, thoracic radiography and CT, and nasotracheal endoscopy led to the diagnosis of tracheal collapse and stenosis secondary to perinatal rib fractures. Neither calf had evidence of substantial lower airway disease. TREATMENT AND OUTCOME: Both calves were discharged from the hospital with the recommendation that they be individually housed in cool, well-ventilated stalls with no access to headlocks. The clinical signs abated, and surgical intervention was not pursued in either patient. Both patients grew as expected and achieved reproductive maturity, with patient 1 becoming an oocyte donor and patient 2 being purchased by a commercial bull stud company. Patient 1 was reevaluated at 21 months old, and patient 2 was reevaluated at 26 months old. Results of follow-up thoracic radiographic (patient 1) and nasotracheal endoscopic (both patients) examinations indicated an anatomically normal trachea with no evidence of collapse or stenosis. CLINICAL RELEVANCE: This report was the first to describe successful resolution of tracheal collapse and stenosis secondary to perinatal rib fracture in dairy calves without surgical intervention.

The effect of foot-and-mouth disease vaccination on early pregnancy loss in beef heifers in Argentina.

The threat of Foot and Mouth Disease (FMD) in South America has global economic implications and retaining a FMD Free status under the World Organization for Animal Health (OIE) remains a top priority. In Argentina the Servicio Nacional de Sanidad y Calidad Agroalimentaria (SENASA), the national service of agri-food health and quality, requires cattle located in the Pampean region of the Salado River basin to receive two foot-and-mouth disease (FMD) vaccinations per year, which results in one vaccination coinciding with beef cattle breeding season. While the vaccination program remains necessary, there is a growing concern amongst food animal veterinarians, that the overlap of FMD vaccination with the first 35 days of the breeding season is associated with early pregnancy loss (EPL). To address this concern, a preliminary randomized controlled trial t study was conducted to investigate the risk ratio (RR) of EPL in vaccinated, pregnant Aberdeen Angus heifers. Initially (Day 0), 858 heifers underwent fixed time-AI (FTAI). Subsequently, on day 33, following pregnancy diagnosis by transrectal ultrasonography pregnant heifers (n = 311) were randomly allocated to two treatment groups. Group 1 (162 animals) received an inactivated oil emulsion FMD vaccine, and Group 2 (149 animals) received a saline injection (control). On day 51 (18 days post vaccination), pregnancy status was re-evaluated by ultrasonography. The initial pregnancy rate (PR) on Day 33 was 58% (498/858 animals). On Day 51 (18 days post vaccination), PR in Group 1 was 96.3% (156/162 animals), and in Group 2 (control) was 98.6% (147/149 animals). The EPL in Group 1 was 3.7% (6/162 animals) and in Group 2 was 1.3% (2/149 animals). The RR of EPL in Group 1, compared to Group 2, was 2.8 (95% confidence interval: 0.6-13, p-value: 0.20). With such a wide range in confidence intervals and a p value of 0.20 a larger prospective study would be necessary to establish an unequivocally statistically significant link between heifer vaccination 33 days post FTAI and an increased risk of EPL.

Salmonella in Dairy Cattle.

As an infectious, contagious pathogen, Salmonella is probably rivaled by only bovine viral diarrhea virus in its ability to cause clinical disease, such as enteritis, septicemia, pneumonia, and reproductive losses. The increasing prevalence of Salmonella, particularly Salmonella Dublin, on dairies presents new challenges to producers and veterinarians. No current discussion of bovine salmonellosis is complete without acknowledging the increasing public health concern. Increasing antimicrobial resistance among enteric pathogens brings the use of antimicrobials by veterinarians and producers under ever stricter scrutiny. This article provides a comprehensive review of Salmonella etiology, prevalence, pathogenesis, diagnostics, treatment, and control.

Identification by next-generation sequencing of Aichivirus B in a calf with enterocolitis and neurologic signs.

An 11-d-old Holstein bull calf was presented to the Veterinary Medical Teaching Hospital at the University of Wisconsin-Madison because of a 4-d history of diarrhea and persistent low-grade fever. Initial diagnosis was enteritis caused by Cryptosporidium and rotavirus. During hospitalization, the calf became stuporous and was only responsive to noxious stimuli, with hypotonia of all 4 limbs, tail, head, and neck. A cerebrospinal fluid analysis revealed xanthochromia, with marked lymphocytic pleocytosis, which was suggestive of viral meningitis and/or encephalitis. Aichivirus B, which belongs to the Kobuvirus genus, was tentatively identified in spinal fluid by next-generation DNA sequencing. This virus can affect a multitude of species, including humans and cattle, and has been isolated from both healthy and diarrheic individuals. However, to date, a possible connection with neurologic disease has not been described, to our knowledge.

Defining colloid osmotic pressure and the relationship between blood proteins and colloid osmotic pressure in dairy cows and calves.

OBJECTIVE: To establish the reference interval for colloid osmotic pressure (COP) in neonatal and adult cattle and to investigate associations between COP and total protein, albumin, or globulin in the two populations sampled. DESIGN: Cross-sectional observational study. SETTING: Animals were sampled on commercial dairy farms in Southern Wisconsin, and samples were processed and analyzed in a clinical pathology laboratory at a university teaching hospital. ANIMALS: Forty adult lactating Holstein cows between 2 and 4 years of age and 40 healthy Holstein calves of both sexes between 2 and 7 days of age. INTERVENTIONS: Adult cows were sampled by coccygeal venipuncture into standard heparinized vacutainer tubes, calves were sampled by jugular venipuncture also into heparinized vacutainer tubes. MEASUREMENTS AND MAIN RESULTS: For adult cows, the mean COP was 22.52 mm Hg, with a standard deviation of 1.0. For calves, the mean COP was 19.6 mm Hg, with a standard deviation of 1.9. Good correlation was demonstrated in adults between COP and albumin concentrations (r(2) = 0.72) and between COP and both total protein concentration (r(2) = 0.74) and globulin (r(2) = 0.65) in calves. For adults, regression plots established best fit relationships of COP = 0.472 (albumin) + 6.49, whereas for calves, two regression equations could be described; COP = 0.305 (globulin) + 8.62, and 0.268 (total plasma protein) + 2.73. CONCLUSIONS: Suggested normal ranges (mean ± 2 standard deviations) for COP in adult lactating dairy cows and calves between 2 and 7 days of age were 21-25 mm Hg and 17-23 mm Hg, respectively.

Cavernous sinus syndrome in a Holstein bull.

A 13-month-old Holstein bull was presented for right-sided exophthalmos. Ophthalmologic examination noted that the animal was visual in both eyes, but that the right pupil was persistently dilated and very sluggish to constrict when stimulated with a bright light and that normal ocular motility was absent. Fundic examination of the right eye was normal as was a complete ophthalmologic examination of the left eye. Radiographs at presentation did not reveal the presence of sinusitis or other skull abnormalities. Initial treatment comprised intravenous antibiotics and anti-inflammatories for orbital inflammation over a 14-day period. There was no perceptible change in the appearance or neuro-ophthalmologic examination of the right eye during hospitalization. The animal was discharged to the owner's care, but 3 weeks later was found recumbent with unilateral strabismus of the left eye and a fixed right pupil. Due to the inability to rise and rapid deterioration, humane euthanasia was performed, and a full postmortem examination, preceded by a MRI, was performed that identified abscesses extending bilaterally through the round foramina obliterating the cavernous sinus region, as well as abscessation of the right mandible, right trigeminal neuritis, right-sided sinusitis, and right-sided otitis media. Cavernous sinus syndrome should be considered in cattle with a combination of exophthalmos and neuro-ophthalmologic abnormalities involving cranial nerves III, IV, V, and VI, whose branches are located within the cavernous sinus.

Timely diagnosis of dairy calf respiratory disease using a standardized scoring system.

Respiratory disease of young dairy calves is a significant cause of morbidity, mortality, economic loss, and animal welfare concern but there is no gold standard diagnostic test for antemortem diagnosis. Clinical signs typically used to make a diagnosis of respiratory disease of calves are fever, cough, ocular or nasal discharge, abnormal breathing, and auscultation of abnormal lung sounds. Unfortunately, routine screening of calves for respiratory disease on the farm is rarely performed and until more comprehensive, practical and affordable respiratory disease-screening tools such as accelerometers, pedometers, appetite monitors, feed consumption detection systems, remote temperature recording devices, radiant heat detectors, electronic stethoscopes, and thoracic ultrasound are validated, timely diagnosis of respiratory disease can be facilitated using a standardized scoring system. We have developed a scoring system that attributes severity scores to each of four clinical parameters; rectal temperature, cough, nasal discharge, ocular discharge or ear position. A total respiratory score of five points or higher (provided that at least two abnormal parameters are observed) can be used to distinguish affected from unaffected calves. This can be applied as a screening tool twice-weekly to identify pre-weaned calves with respiratory disease thereby facilitating early detection. Coupled with effective treatment protocols, this scoring system will reduce post-weaning pneumonia, chronic pneumonia, and otitis media.

Diagnosis and surgical treatment of an intracranial cyst in an alpaca cria.

CASE DESCRIPTION: A 7-day-old female alpaca was examined because of an acute onset of diffuse central neurologic deficits. CLINICAL FINDINGS: Diagnostic imaging with CT and MRI identified an intracranial cyst occupying approximately one-third to one-half of the dorsal portion of the cranial cavity, markedly displacing the cerebral hemispheres bilaterally. TREATMENT AND OUTCOME: Initial surgical management via trephination and needle drainage was only transiently effective at resolving the neurologic signs. Craniotomy and drainage and removal of the cyst lining resulted in a sustained improvement in neurologic status, and the cria remained clinically normal and well grown at follow-up 5 months after surgery. CLINICAL RELEVANCE: This report represented the first description of the successful treatment of an intracranial cyst in a New World camelid.

Incidence of transfusion reactions to commercial equine plasma.

OBJECTIVE: To report on the incidence of transfusion reactions to commercial equine plasma in a hospital-based population of horses, to characterize these reactions and report on outcome. DESIGN: Retrospective study. SETTING: University teaching hospital. ANIMALS: Client-owned horses referred to the University of Wisconsin. INTERVENTIONS: Intravenous administration of 2 commercial equine plasma products when clinically indicated. MEASUREMENTS AND MAIN RESULTS: Medical records of 107 horses that received plasma transfusions between 2003 and 2008 were evaluated. Transfusion reactions were recorded in 6 of 107 transfusions. All individuals were administered plasma from 1 commercial source. Foals <30 days of age received a hypergammaglobulinemic product and all adults received a lower IgG concentration product. No reactions were recorded in adults. In foals (<30 d) reactions were recorded in 6 of 69 cases (8.7%), all of which occurred in neonates <7 days of age (6/62; [9.7%]). The most frequent reactions were fever (4/6), tachycardia (2/6), tachypnea (2/6), and colic (2/6). All affected foals survived the reaction. There were no statistically significant differences (P<0.05) in any of the variables examined between those foals that did and those that did not experience transfusion reactions. CONCLUSION: The incidence of transfusion reactions was 8.7% in foals and 0% in adult horses in our referral population. Five of 6 foals responded to medical therapy and eventually received the clinically indicated transfusion. No transfusion related mortality occurred.

Equine PSGL-1 modifications required for P-selectin binding.

Equine PSGL-1 (ePSGL-1) is widely expressed on equine PBMC as a homodimer with sialylation (sLeX) modifications that contribute to P-selectin binding affinity. To investigate the role of other potential post-translational modifications required for high-affinity P-selectin binding, ePSGL-1 was transfected into CHO cells expressing equine FucT-VII and/or C2GnT. P-selectin-IgG chimera binding by ePSGL-1 transfected into CHO cells only occurred when both FucT-VII and C2GnT were expressed, establishing that fucosylation and core-2 branching are required as post-translational modifications for high-affinity P-selectin binding. However, enzymatic removal of N-glycans or site and/or point-mutation preventing N-glycan addition did not inhibit P-selectin binding, indicating that N-glycosylation is not required. Taken together, we hypothesized that sialylation, fucosylation, or core-2 branching must occur on O-glycans. The presence of numerous serine/threonine residues in the ePSGL-1 extracellular domain suggests several potential O-glycans attachment sites. P-selectin binding was also susceptible to OSGP cleavage, providing evidence for the existence of clustered, sialyated O-glycans on ePSGL-1. Because OSGP eliminated ePSGL-1 precipitation the P-selectin binding domain of ePSGL-1 must contain clustered, sialyated, fucosylated, and core-2 branched O-glycans. Using point-mutation deletion techniques, the binding domain was determined to reside between residues 48 and 100 of ePSGL-1. Sulfation, a critical modification for human PSGL-1 binding to P-selectin, was not necessary for equine P-selectin binding, while dimerization of ePSGL-1 was critical. These species-specific features of equine PSGL-1 provide new information that advances our understanding of high-affinity P-selectin binding mediated mononuclear cell trafficking.

Surgical findings and outcome for dairy cattle with jejunal hemorrhage syndrome: 31 cases (2000-2007).

OBJECTIVE: To describe signalment; surgical findings; short-, medium-, and long-term outcome; and recurrence rate for cattle undergoing celiotomy because of jejunal hemorrhage syndrome (JHS) and to analyze risk factors associated with outcome and recurrence. DESIGN: Retrospective case series. ANIMALS: 31 dairy cattle with JHS. PROCEDURES: Medical records were analyzed. Follow-up information was obtained from owners of cattle surviving until discharge. RESULTS: 18 of 31 (58%) cattle undergoing celiotomy survived to initial discharge. Fifteen (48%) and 13 (42%) were alive 6 and 12 months after discharge, respectively. All 5 deaths within 12 months after discharge were attributed to JHS recurrence. Survival time was 12 to 85 months for the 13 long-term survivors. Six of 7 that died > 12 months after celiotomy did so for reasons unrelated to JHS. Recurrence rate among short-term survivors was 7 of 18; 1 of these survived long-term. A significant proportion of affected cattle were Brown Swiss, compared with proportions for other breeds. Manual massage of the bowel to break down clots was associated with a significantly higher short-term survival rate than was enterectomy or enterotomy. Medium- and long-term survival rate was higher in cattle referred 24 to 48 hours after onset of signs. Length of obstructing blood clots was not associated with outcome. Other factors were not significantly associated with recurrence. CONCLUSIONS AND CLINICAL RELEVANCE: Survival rates were higher than those in other reports. Prompt celiotomy and resolution by use of manual massage were associated with higher survival rates. In this population, JHS recurred in 7 of 18 short-term survivors.

Cardiac isoenzymes in healthy Holstein calves and calves with experimentally induced endotoxemia.

This paper describes a controlled study designed to establish normal values for cardiac troponins I and T (cTnI and cTnT) and CK-MB mass in healthy newborn Holstein calves, and to compare values for cTnI, cTnT, CK-MB and total creatine kinase (CK) with age-matched calves experiencing experimentally induced endotoxemia. Nineteen healthy Holstein bull calves, 48 to 72 h of age were used. Baseline cTnI, cTnT, CK-MB and total CK measurements were obtained from control (n = 9) and experimental (n = 10) calves. Controls then received physiological saline and experimental calves received endotoxin (O55:B5 Escherichia coli LPS) intravenously after which cardiac biomarkers and total CK were measured at 3 h, 6 h, 12 h, and 24 h post-initiation of infusion. Measured values were analyzed and compared using analysis of variance (ANOVA) by repeated measure design, with statistical significance set at P < 0.05. The cardiac biomarker cTnT was not detected in any calf at any time point, and CK-MB was only detected in 5 of 95 samples. The cTnI was significantly increased compared to baseline and controls, 3 h post lipopolysaccharide (LPS) infusion. Total CK was significantly increased in LPS administered calves at 18 and 24 h post infusion. The mean, standard deviation, and range for cTnI in healthy controls were 0.023 ng/mL (s = 0.01), and 0.01 to 0.05 ng/mL, respectively. In conclusion, LPS administration was associated with rapid and significant increases in cTnI but CK-MB and cTnT were not detected in the plasma of healthy calves. Total CK values increased significantly following LPS administration. Biochemical evidence of myocardial injury occurs within 3 h following LPS administration to neonatal Holstein calves.

Characterization of equine P-selectin glycoprotein ligand-1 by using a specific monoclonal antibody.

P-selectin glycoprotein ligand (PSGL-1) is a widely distributed adhesion molecule that plays a critical role in regulating lymphocyte homing and leukocyte trafficking during inflammation. The lack of specific reagents for equine PSGL-1 (ePSGL-1) has prevented mechanistic studies regarding its function and regulation in the horse. We synthesized a ePSGL-1 peptide to generate a monoclonal antibody (mAb), ePL1. Using flow cytometry and Western blot, we showed that ePL1 binds specifically to ePSGL-1 in transfected mammalian cells. We also demonstrated that ePL1 binds to equine leukocytes and recognized a protein with molecular weight 165 and 280kDa under reducing and non-reducing condition, respectively, likely corresponding to ePSGL-1. Seventy percent of equine monocytes bound by both ePL1 and HECA-452, an antibody defining sLex-like carbohydrate epitope. Both ePL1 and HECA-452 recognized ePSGL-1 protein precipitated by equine P-selectin-IgG chimera. Neuraminidase treatment increased ePL1 binding and the molecular weight of ePSGL-1, O-sialoglycoprotein endopeptidase digestion and tyrosine mutation abolished ePL1 staining and recognition. The ePL1 specific binding epitope appears to be the polypeptide backbone of ePSGL-1 in the presence of tyrosine but the process is independent of sialylation modification. In conclusion, we provide evidence that this antibody can be used for cell surface staining and immune-blot analyses.

Cloning and functional characterization of recombinant equine P-selectin.

The recent molecular characterization and sequencing of equine P-selectin (ePsel), and its glycoprotein ligand, P-selectin glycoprotein ligand-1 (PSGL-1), have provided the tools for further investigation into their role in leukocyte trafficking. Here, we report the generation of a genetically engineered chimeric protein (ePsel-IgG) in which the equine P-selectin lectin and epithelial growth factor (EGF) domains were covalently linked to the equine IgG1 heavy chain constant region. The soluble ePsel-IgG was observed to bind to equine monocytes by confocal microscopy and flow cytometry. Furthermore, equine monocytes bound to immobilized ePsel-IgG in a time course and dose dependent manner. Not only did ePsel-IgG act as an adhesion molecule, it was also found to activate ERK1/2 kinase and induce IL-8 mRNA expression in equine monocytes. That all of the aforementioned ePsel-IgG-induced cell binding and cell signaling were abolished by the addition of EDTA, suggested that ePsel-IgG chimera mediated events occurred via the P-selectin ligand, PSGL-1. We were able to demonstrate that 78% of equine monocytes cross-reacted with anti-human HECA-452 antibody, which recognizes the sialy-Lewis X (sLex) epitope, a well-known carbohydrate binding site on human PSGL-1. Pre-incubation of equine PBMC with neuraminidase or O-sialoglycoprotein endopeptidase (OSGP) reduced ePsel-IgG monocyte binding to 36% or 60%, respectively. Taken together, these data suggest that there might be two ligand recognition sites on P-selectin, one of which recognizes sLex and another which recognizes P-selectin ligand core protein. The ePsel-IgG chimera can be a useful as a reagent for further studies on the role of equine P-selectin and signal transduction in inflammatory events in horse.

Prognostic value of clinicopathologic variables obtained at admission and effect of antiendotoxin plasma on survival in septic and critically ill foals.

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.