New Diagnostic Score for Sepsis in Adult Horses with Acute Gastrointestinal Disease.

Overview

• This study developed a new diagnostic score to identify sepsis in adult horses suffering from acute gastrointestinal disease, particularly colic.
• The score is based on clinical and laboratory parameters and aims to improve diagnosis by maximizing test accuracy, sensitivity, and specificity.

Introduction and Background

• Colic is a major cause of death in horses and is often complicated by systemic inflammation and organ dysfunction.
• In human medicine, similar complications are classified as sepsis, which involves organ dysfunction caused by a harmful, life-threatening immune response to infection.
• Although sepsis is recognized in horses, no standardized diagnostic scoring system existed for adult horses prior to this study.
• The motivation behind this research was to develop a reliable, practical diagnostic tool to identify sepsis in adult horses with acute gastrointestinal disease.

Study Design and Methods

• This was a retrospective study analyzing medical records of 295 adult horses admitted for colic at the Oniris equine emergency department in Nantes, France.
• The timeframe for record analysis spanned more than 10 years, from July 2011 to November 2021.
• Horses were categorized into groups based on their final diagnosis: either sepsis or non-septic colic.
• Various clinical signs and laboratory data were gathered for analysis, including parameters like temperature, heart rate, blood counts, and specific biomarkers.
• Statistical analyses (both univariate and multivariate logistic regression) were performed to identify which parameters best predicted sepsis.
• The researchers created a scoring model by selecting the most predictive parameters and determining an optimal threshold to balance sensitivity and specificity.

Key Findings

• Out of 295 horses studied, 89 (30.2%) were diagnosed with sepsis.
• Six parameters were identified as significant predictors and included in the final scoring model:
  • Temperature
  • Heart rate
  • Leukocyte count (white blood cells)
  • Red blood cell count
  • Creatine kinase (an enzyme indicating muscle damage)
  • Lactate levels (a marker of poor tissue oxygenation)
• The diagnostic score achieved:
  • 79% overall accuracy in diagnosing sepsis
  • 59% sensitivity (ability to correctly identify true septic cases)
  • 88% specificity (ability to correctly identify non-septic cases)
• Setting the score threshold at 3 yielded:
  • 52.7% sensitivity
  • 91.6% specificity
  • A Youden index of 0.44 (a combined measure of sensitivity and specificity)

Implications and Conclusion

• The study proposes a rapid and practical sepsis diagnostic score tailored for adult horses with acute gastrointestinal disease.
• This scoring tool is highly specific, meaning it is particularly useful for confirming sepsis diagnosis and ruling out false positives.
• Such a score can assist veterinarians in making timely and accurate decisions about treatment and management of septic horses.
• By improving sepsis diagnosis, outcomes for horses presenting with colic and systemic inflammation may be enhanced through earlier and targeted interventions.
• Future steps might include prospective validation of the score in different populations and clinical settings.