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Equine veterinary journal2026; doi: 10.1002/evj.70202

Development of a prognostic scoring system for systemic inflammatory response syndrome in donkeys.

Abstract: Systemic inflammatory response syndrome (SIRS) is associated with increased mortality in horses with gastrointestinal (GI) disease. However, there are no data relating to naturally occurring SIRS in donkeys. Objective: To determine SIRS frequency in donkeys with GI disease. To develop a donkey-specific prognostic SIRS score. Methods: Retrospective case series. Methods: Clinical records from donkeys presenting with GI disease in two independent cohorts (development cohort: n = 400, UK; validation cohort: n = 36, Australia) were reviewed. Age, sex, heart rate, respiratory rate, rectal temperature, white blood cell count (WBCC), neutrophil%, neutrophil count, packed cell volume (PCV), total protein (TP), PCV/TP ratio, triglycerides, albumin, creatinine, urea, serum amyloid A, and outcome were recorded. SIRS scores validated for horses (hSIRS, 0-4) were calculated. Prognostic factors were identified in the development cohort using generalised estimating equations and receiver operator characteristic analysis. A novel donkey SIRS score (dSIRS, 0-6) was developed and applied to the second cohort for validation. A traffic light system was further devised to classify individuals as low-, medium-, and high-risk of non-survival. Results: In the development cohort, 32.1% cases fulfilled the hSIRS criteria. The fatality rate was 45.6% in these cases. Only two of the hSIRS criteria (heart rate >56 bpm; WBCC 13.8 × 10/L) were significant predictors of outcome. The dSIRS score included heart rate, WBCC, age (15-25; or >25 years), PCV/TP ratio (>0.5725), and [triglyceride] (>2.8 mmol/L). In the development cohort, the dSIRS score predicted outcome with 78.3% accuracy (sensitivity: 62.7% [95% CI: 51.9-72.3]; specificity: 83.5% [78.4-87.5]). In the validation cohort, accuracy was 81% (sensitivity: 100% [79.6-100.0], specificity: 47.6% [28.3-67.6]). Conclusions: Retrospective study, small validation cohort. Conclusions: The frequency of SIRS and associated fatality rate in donkeys with GI disease is high. After further validation through a prospective study, the dSIRS score could be a valuable prognostic tool.
© 2026 The Author(s). Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2026-05-31 PubMed ID: 42219234DOI: 10.1002/evj.70202Google Scholar: Lookup
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Summary

This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.

Overview

  • This research aimed to determine how often systemic inflammatory response syndrome (SIRS) occurs in donkeys with gastrointestinal disease and to develop a donkey-specific prognostic scoring system to predict survival outcomes.
  • The study analyzed clinical data from donkeys in the UK and Australia to create and validate a new SIRS scoring system tailored to donkeys (dSIRS), which showed promising accuracy in predicting mortality risk.

Background and Rationale

  • SIRS is known to increase mortality in horses with gastrointestinal (GI) disease.
  • There was a lack of data on SIRS in donkeys, despite their unique physiological differences from horses.
  • The study aimed to fill this knowledge gap by determining the frequency of SIRS in donkeys with naturally occurring GI disease.
  • Additionally, the study sought to develop a prognostic scoring system specific to donkeys, as existing horse SIRS scores may not be accurate for this species.

Methods

  • Design: Retrospective case series involving donkeys presenting with GI disease.
  • Data Source: Clinical records were reviewed from two independent cohorts:
    • Development cohort (n=400 donkeys) from the UK.
    • Validation cohort (n=36 donkeys) from Australia.
  • Data Collected: Demographic and clinical variables including age, sex, heart rate, respiratory rate, rectal temperature, white blood cell count (WBCC) and percentage neutrophils, packed cell volume (PCV), total protein (TP), PCV/TP ratio, triglycerides, albumin, creatinine, urea, and serum amyloid A.
  • Outcome measured was survival or non-survival.
  • SIRS Scores: Existing horse SIRS score (hSIRS, range 0-4) was calculated for comparison.
  • Statistical Analysis:
    • Used generalized estimating equations and receiver operator characteristic (ROC) curve analysis to identify prognostic factors in the development cohort.
    • Developed a new donkey-specific SIRS scoring system (dSIRS, range 0-6) based on significant predictors.
    • Applied and validated the dSIRS score in the Australian cohort.
    • Created a ‘traffic light’ risk classification system to categorize donkeys into low, medium, and high risk for mortality.

Key Results

  • Frequency of SIRS in the development cohort: 32.1% of donkeys met the horse SIRS criteria.
  • Mortality rate in donkeys meeting hSIRS criteria was high at 45.6%.
  • Only two horse SIRS criteria (heart rate > 56 bpm, and abnormal WBCC 13.8 ×10^9/L) significantly predicted survival outcomes in donkeys.
  • The newly developed donkey SIRS (dSIRS) score incorporated:
    • Heart rate
    • White blood cell count (WBCC)
    • Age categories (15–25 years or >25 years)
    • PCV/total protein ratio (> 0.5725)
    • Triglyceride levels (> 2.8 mmol/L)
  • Prognostic Accuracy:
    • In the development cohort:
      • Overall accuracy: 78.3%
      • Sensitivity: 62.7% (ability to correctly identify non-survivors)
      • Specificity: 83.5% (ability to correctly identify survivors)
    • In the smaller validation cohort:
      • Overall accuracy: 81%
      • Sensitivity: 100% (perfect prediction of non-survival)
      • Specificity: 47.6% (moderate prediction of survival)

Conclusions and Implications

  • SIRS is a relatively common and serious condition in donkeys with gastrointestinal disease, associated with high fatality rates.
  • The existing horse SIRS scoring system only partially predicted donkey outcomes.
  • The newly developed donkey SIRS (dSIRS) score, which includes clinical signs, age, and laboratory data, improved the ability to predict survival outcomes.
  • The dSIRS score can serve as a practical, evidence-based prognostic tool for veterinarians managing donkeys with GI disease once further validation is completed.
  • The study was retrospective with a relatively small validation cohort; therefore, prospective studies with larger sample sizes are needed to confirm and refine the dSIRS score’s clinical utility.
  • The use of a simple ‘traffic light’ risk classification based on the dSIRS score facilitates easy clinical decision-making and risk communication with donkey caretakers.

Cite This Article

APA
Barnabé MA, Bamford NJ, Elliott J, Chang YM, Rickards K, Menzies-Gow NJ. (2026). Development of a prognostic scoring system for systemic inflammatory response syndrome in donkeys. Equine Vet J. https://doi.org/10.1002/evj.70202

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English

Researcher Affiliations

Barnabé, Marine A
  • Department of Comparative Biomedical Sciences, Royal Veterinary College, Hertfordshire, UK.
Bamford, Nicholas J
  • Melbourne Veterinary School, The University of Melbourne, Parkville, Victoria, Australia.
Elliott, Jonathan
  • Department of Comparative Biomedical Sciences, Royal Veterinary College, Hertfordshire, UK.
Chang, Yu-Mei
  • Department of Comparative Biomedical Sciences, Royal Veterinary College, Hertfordshire, UK.
Rickards, Karen
  • The Donkey Sanctuary, UK.
Menzies-Gow, Nicola J
  • Department of Clinical Sciences and Services, Royal Veterinary College, Hertfordshire, UK.

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