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Journal of veterinary internal medicine2024; 39(1); e17269; doi: 10.1111/jvim.17269

Retrospective cohort study on diseases and risk factors associated with death in hospitalized neonatal foals.

Abstract: The care of sick neonatal foals is labor-intensive and costly. Prediction of risk of death upon admission is often difficult but might support decision-making. Objective: To determine diseases and risk factors associated with death in neonatal hospitalized foals. Methods: Two hundred twenty-two hospitalized foals, ≤7 days old. Methods: Retrospective cohort study. Clinical and laboratory variables were evaluated for their association with death by means of Cox survival analysis and by classification and regression tree (CART) analysis. Results: Most prevalent diseases were sepsis (43.9%), enteritis (14.0%), and omphalitis (9.0%). Case fatality rate was 33.3%. Neonatal sepsis significantly increased the risk of death (hazard ratio [HR] = 1.9; 95% confidence interval [CI] = 1.2-3.0; P = .009). Multivariable Cox regression in foals ≤7 days old revealed comatose mental state (HR = 2.9; 95% CI = 1.1-8.1; P = .04), L-lactatemia (≥373.8 mg/L [4.2 mmol/L]; HR = 4.4; 95% CI = 1.7-11.7; P = .003) and increased serum amyloid A (SAA; ≥2054 μg/mL; HR = 3.9; 95% CI = 1.2-12.7; P = .02) as risk factors for death, with a sensitivity and specificity of 7.5% and 95.7%, respectively. The CART analysis highlighted L-lactatemia, comatose mental state, and hypercapnia as risk factors for death, with a sensitivity of 38.1% and specificity of 86.1% after validation. Conclusions: In this study sample, sepsis was associated with the highest risk of death. Identified risk factors such as SAA, L-lactate, and comatose mental state might guide veterinarians and owners in better decision-making for economic or welfare reasons. Frequently measured laboratory variables, such as blood glucose concentration and Immunoglobulin G, were not sensitive and specific enough to provide reliable decision support for survival estimation.
© 2024 The Author(s). Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
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Publication Date: 2024-12-18 PubMed ID: 39690128PubMed Central: PMC11652109DOI: 10.1111/jvim.17269Google 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.

The study aimed to identify diseases and related risk factors that increase the risk of death in hospitalized newborn horses (foals). The researchers found that sepsis presented the highest mortality risk, and factors like l-lactatemia, comatose mental state, and increased serum amyloid A (SAA) levels also elevated the chances of death. They concluded that these risk factors could aid in making decisions for treatment or welfare purposes.

Study Methodology

  • The study was a retrospective cohort investigation involving 222 hospitalized foals aged 7 days or less.
  • The researchers evaluated several clinical and laboratory variables to determine their association with mortality, employing statistical techniques, namely Cox survival analysis and classification and regression tree (CART) analysis.

Key Findings

  • The most frequently observed diseases among the hospitalized foals were sepsis, enteritis, and omphalitis.
  • The case fatality rate reported was 33.3%.
  • Sepsis significantly increased the mortality risk with a hazard ratio of 1.9.
  • For foals aged 7 days or less, the factors posing a high risk of death included a comatose mental state, elevated levels of L-lactate (l-lactatemia), and higher serum amyloid A (SAA) concentrations.
  • These three factors demonstrated a specificity of 95.7% and a rather low sensitivity of 7.5% in the multivariable Cox regression analysis.
  • The CART analysis reaffirmed L-lactatemia and a comatose mental state as mortality risk factors. Also, it introduced hypercapnia (excessive carbon dioxide in the bloodstream) as another risk factor, with a sensitivity and specificity of 38.1% and 86.1% respectively.

Conclusions and Implications

  • Among the diseases assessed, sepsis accounted for the highest risk of death in the study.
  • Identified risk factors, including elevated levels of SAA and L-lactate as well as a comatose mental state, could assist veterinarians and owners in making better treatment decisions for economical or welfare purposes.
  • Typical laboratory variables like blood glucose concentration and Immunoglobulin G levels did not prove to be sensitive or specific enough to effectively predict survival.

Cite This Article

APA
Castelain DL, Dufourni A, Pas ML, Bokma J, de Bruijn E, Paulussen E, Lefère L, van Loon G, Pardon B. (2024). Retrospective cohort study on diseases and risk factors associated with death in hospitalized neonatal foals. J Vet Intern Med, 39(1), e17269. https://doi.org/10.1111/jvim.17269

Publication

Journal of veterinary internal medicine
ISSN: 1939-1676
NlmUniqueID: 8708660
Country: United States
Language: English
Volume: 39
Issue: 1
Pages: e17269

Researcher Affiliations

Castelain, Donatienne L
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
Dufourni, Alexander
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
Pas, Mathilde L
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
Bokma, Jade
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
de Bruijn, Eva
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
Paulussen, Ellen
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
Lefère, Laurence
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
van Loon, Gunther
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.
Pardon, Bart
  • Department of Internal Medicine, Reproduction and Population Medicine, Ghent University, Salisburylaan 133, Merelbeke 9820, Belgium.

MeSH Terms

  • Animals
  • Retrospective Studies
  • Horses
  • Horse Diseases / mortality
  • Risk Factors
  • Animals, Newborn
  • Male
  • Female
  • Cohort Studies
  • Sepsis / veterinary
  • Sepsis / mortality
  • Hospitalization

Grant Funding

  • RF 21/6351 / FOD Volksgezondheid, Veiligheid van de Voedselketen en Leefmilieu
  • Ghent University

Conflict of Interest Statement

Authors declare no conflict of interest.

References

This article includes 63 references
  1. Koterba AM, Brewer BD, Tarplee FA. Clinical and clinicopathological characteristics of the septicaemic neonatal foal: review of 38 cases. Equine Vet J 1984;16(4):376‐382.
    doi: 10.1111/j.2042-3306.1984.tb01950.xpubmed: 6479139google scholar: lookup
  2. Corley KTT, Donaldson LL, Furr MO. Arterial lactate concentration, hospital survival, sepsis and SIRS in critically ill neonatal foals. Equine Vet J 2005;37(1):53‐59.
    pubmed: 15651735
  3. Hurcombe SDA, Toribio RE, Slovis N. Blood arginine vasopressin, adrenocorticotropin hormone, and cortisol concentrations at admission in septic and critically ill foals and their association with survival. J Vet Intern Med 2008;22(3):639‐647.
    pubmed: 18466247
  4. Dembek KA, Hurcombe SD, Frazer ML, Morresey PR, Toribio RE. Development of a likelihood of survival scoring system for hospitalized equine neonates using generalized boosted regression modeling. PLoS One 2014;9(10):e109212.
    pmc: PMC4189956pubmed: 25295600
  5. Sanchez C, Giguère S, Lester G. Factors associated with survival of neonatal foals with bacteremia and racing performance of surviving Thoroughbreds: 423 cases (1982–2007). Am Vet Med Assoc 2008;233(9):1446‐1452.
    pubmed: 18980499
  6. Castagnetti C, Veronesi MC. Prognostic factors in the sick neonatal foal. Vet Res Commun 2008;32 Suppl 1(SUPPL. 1):87‐91.
    pubmed: 18686000
  7. Wong DM, Ruby RE, Dembek KA. Evaluation of updated sepsis scoring systems and systemic inflammatory response syndrome criteria and their association with sepsis in equine neonates. J Vet Intern Med 2018;32(3):1185‐1193.
    pmc: PMC5980351pubmed: 29582480
  8. Wilkins PA. Prognostic indicators for survival and athletic outcome in critically ill neonatal foals. Vet Clin North Am Equine Pract 2015;31:615‐628.
    pubmed: 26612751
  9. Viu J, Armengou L, Ríos J, Cesarini C, Jose‐Cunilleras E. Acid base imbalances in ill neonatal foals and their association with survival. Equine Vet J 2017;49(1):51‐57.
    pubmed: 26595881
  10. Hoeberg E, Sånge A, Saegerman C. Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals. J Vet Intern Med 2022;36(6):2245‐2253.
    pmc: PMC9708439pubmed: 36239317
  11. Liepman RS, Dembek KA, Slovis NM, Reed SM, Toribio RE. Validation of IgG cut‐off values and their association with survival in neonatal foals. Equine Vet J 2015;47(5):526‐530.
    pubmed: 25683641
  12. Bohlin A, Saegerman C, Hoeberg E. Evaluation of the foal survival score in a Danish‐Swedish population of neonatal foals upon hospital admission. J Vet Intern Med 2019;33(3):1507‐1513.
    pmc: PMC6524090pubmed: 31004404
  13. Hollis AR, Wilkins PA, Palmer JE, Boston RC. Bacteremia in equine neonatal diarrhea: a retrospective study (1990‐2007). J Vet Intern Med 2008;22(5):1203‐1209.
    pubmed: 18638014
  14. Hoffman AM, Staempfli HR, Willan A. Prognostic variables for survival of neonatal foals under intensive care. J Vet Intern Med 1992;6(2):89‐95.
    pubmed: 1588547
  15. Rohrbach BW, Buchanan BR, Drake JM. Use of a multivariable model to estimate the probability of discharge in hospitalized foals that are 7 days of age or less. J Am Vet Med Assoc 2006;228(11):1748‐1756.
    pubmed: 16740076
  16. Saulez MN, Gummow B, Slovis M. Admission clinicopathological data, length of stay, cost and mortality in an equine neonatal intensive care unit. J S Afr Vet Assoc 2007;78(3):153‐157.
    pubmed: 18237039
  17. Pas ML, Bokma J, Lowie T, Boyen F, Pardon B. Sepsis and survival in critically ill calves: risk factors and antimicrobial use. J Vet Intern Med 2023;37(1):374‐389.
    pmc: PMC9889718pubmed: 36562487
  18. Bedenice D, Avila B, Paradis MR. Comparative evaluation of clinical findings and prognostic outcome parameters in hospitalized, critically ill neonatal foals and crias. J Vet Emerg Crit Care 2021;31(5):619‐628.
    pubmed: 34324773
  19. Gayle JM, Cohen ND, Chaffin MK. Factors associated with survival in septicemic foals: 65 cases (1988–1995). J Vet Intern Med 1998;12(3):140‐146.
    pubmed: 9595374
  20. Corley KTT, Pearce G, Magdesian KG, Wilson WD. Bacteraemia in neonatal foals: clinicopathological differences between gram‐positive and gram‐negative infections, and single organism and mixed infections. Equine Vet J 2007;39(1):84‐89.
    pubmed: 17228602
  21. Raisis AL, Hodgson JL, Hodgson DR. Equine neonatal septicaemia: 24 cases. Aust Vet J 1996;73(4):137‐140.
    pubmed: 8660228
  22. Palmer J. Update on the management of neonatal sepsis in horses. Vet Clin North Am Equine Pract 2014;30:317‐336.
    pubmed: 25016494
  23. Mckenzie HC, Furr MO. Equine neonatal sepsis: the pathophysiology of severe inflammation and infection. Comp Cont Educ Prac Vet 2001;23(7):661‐672.
  24. Hatz LA, Hartnack S, Kümmerle J, Hässig M, Bettschart‐Wolfensberger R. A study of measurement of noninvasive blood pressure with the oscillometric device, Sentinel, in isoflurane‐anaesthetized horses. Vet Anaesth Analg 2015;42(4):369‐376.
    pubmed: 25082169
  25. Pardon B, Buczinski S, Deprez PR. Accuracy and inter‐rater reliability of lung auscultation by bovine practitioners when compared with ultrasonographic findings. Vet Rec 2019;185(4):109.
    pubmed: 31320546
  26. Brewer BD, Koterba AM. Development of a scoring system for the early diagnosis of equine neonatal sepsis. Equine Vet J 1988;20(1):18‐22.
    pubmed: 3366100
  27. Furr M, Tinker MK, Edens L. Prognosis for neonatal foals in an intensive care unit. J Vet Intern Med 1997;11(3):183‐188.
    pubmed: 9183771
  28. Hytychová T, Bezděková B. Retrospective evaluation of blood culture isolates and sepsis survival rate in foals in The Czech Republic: 50 cases (2011‐2013). J Vet Emerg Crit Care 2015;25(5):660‐666.
    pubmed: 26220509
  29. Taylor S. A review of equine sepsis. Equine Vet Educ 2015;27(2):109.
    pmc: PMC7163761pubmed: 32313390
  30. Marsh P, Palmer J. Bacterial isolates from blood and their susceptibility patterns in critically ill foals 543 cases (1991‐1998). J Am Vet Med Assoc 2001;218(10):1608‐1610.
    pubmed: 11393374
  31. Wilson D, Madigan J. Comparison of bacteriologic culture of blood and necropsy specimen for determining the cause of foal septicemia 47 cases (1978‐1987). J Am Vet Med Assoc 1989;195(12):1759‐1763.
    pubmed: 2624660
  32. Elsohaby I, Riley CB, McClure JT. Usefulness of digital and optical refractometers for the diagnosis of failure of transfer of passive immunity in neonatal foals. Equine Vet J 2019;51(4):451‐457.
    pubmed: 30417417
  33. Palmisano M, Javsicas L, McNaughten J, Gamsjäger L, Renaud DL, Gomez DE. Effect of plasma transfusion on serum amyloid A concentration in healthy neonatal foals and foals with failure of transfer of passive immunity. J Vet Intern Med 2023;37(2):697‐702.
    pmc: PMC10061169pubmed: 36825688
  34. Ujvari S, Schwarzwald CC, Fouché N, Howard J, Schoster A. Validation of a point‐of‐care quantitative equine IgG turbidimetric immunoassay and comparison of IgG concentrations measured with radial immunodiffusion and a point‐of‐care IgG ELISA. J Vet Intern Med 2017;31(4):1170‐1177.
    pmc: PMC5508326pubmed: 28561898
  35. Davis DG, Schaefer DMW, Hinchcliff KW, Wellman ML, Willet VE, Fletcher JM. Measurement of serum IgG in foals by radial immunodiffusion and automated turbidimetric immunoassay. J Vet Intern Med 2005;19(1):93‐96.
    pubmed: 15715054
  36. Metzger N, Hinchcliff KW, Hardy J, Schwarzwald CC, Wittum T. Usefulness of a commercial equine IgG test and serum protein concentration as indicators of failure of transfer of passive immunity in hospitalized foals. J Vet Intern Med 2006;20(2):382‐387.
    pubmed: 16594598
  37. Sobiraj A, Herfen K, Bostedt H. Clinical symptoms and laboratory data in newborn foals with sepsis‐a retrospective analysis. Pferdeheilkunde 2001;17(6):673‐675.
  38. Barr B, Nieman NM. Serum amyloid A as an aid in diagnosing sepsis in equine neonates. Equine Vet J 2022;54(5):922‐926.
    pubmed: 34773677
  39. Belgrave R, Dickey M, Arheart K, Cray C. Assessment of serum amyloid A testing of horses and its clinical application in a specialized equine practice. J Am Vet Med Assoc 2013;243:113‐119.
    pubmed: 23786199
  40. Duggan V. Serum amyloid A in the neonatal foal: the significance of peri‐parturient events. Vet J 2008;176:267‐269.
    pubmed: 17928246
  41. Liu G, Lv H, An Y, Wei X, Yi X, Yi H. Early lactate levels for prediction of mortality in patients with sepsis or septic shock: a meta‐analysis. Int J Clin Exp Med 2017;10(1):37‐47.
  42. Morris E, McCartney D, Lasserson D, Van Den Bruel A, Fisher R, Hayward G. Point‐of‐care lactate testing for sepsis at presentation to health care: a systematic review of patient outcomes. Br J Gen Pract 2017;67(665):e859‐e870.
    pmc: PMC5697556pubmed: 29158243
  43. Borthwick HA, Brunt LK, Mitchem KL, Chaloner C. Does lactate measurement performed on admission predict clinical outcome on the intensive care unit? A concise systematic review. Ann Clin Biochem 2012;49(4):391‐394.
    pubmed: 22715295
  44. Evans L, Rhodes A, Alhazzani W. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021;47(11):1181‐1247.
    pmc: PMC8486643pubmed: 34599691
  45. Lee SM, An WS. New clinical criteria for septic shock: serum lactate level as new emerging vital sign. J Thorac Dis 2016;8(7):1388.
    pmc: PMC4958885pubmed: 27501243
  46. Hollis AR, Furr MO, Magdesian KG. Blood glucose concentrations in critically ill neonatal foals. J Vet Intern Med 2008;22(5):1223‐1227.
    pubmed: 18691362
  47. Castagnetti C, Pirrone A, Mariella J, Mari G. Venous blood lactate evaluation in equine neonatal intensive care. Theriogenology 2010;73(3):343‐357.
    pubmed: 19962183
  48. Gerber KL, Freeman KP. ASVCP guidelines: quality assurance for portable blood glucose meter (glucometer) use in veterinary medicine. Vet Clin Pathol 2016;45(1):10‐27.
    pubmed: 26748942
  49. Furr M, McKenzie H. Factors associated with the risk of positive blood culture in neonatal foals presented to a referral center (2000‐2014). J Vet Intern Med 2020;34(6):2738‐2750.
    pmc: PMC7694804pubmed: 33044020
  50. Haas SD, Bristol F, Card CE. Risk factors associated with the incidence of foal mortality in an extensively managed mare herd. Can Vet J 1996;37(2):91‐95.
    pmc: PMC1576626pubmed: 8640655
  51. Pusterla N, Pusterla JB, Spier SJ, Puget B, Watson JL. Evaluation of the SNAP foal IgG test for the semiquantitative measurement of immunoglobin G in foals. Vet Rec 2002;151(9):258‐260.
    pubmed: 12233826
  52. Kasap S, Babaeski S, Yildirim KN, Orman A, Temizel EM, Kennerman E. Evaluation of glutaraldehyde coagulation test and colostrum BRIX refractometer compared with SNAP foal IgG test in neonatal foals. Equine Vet J 2023;56:1077‐1082.
    pubmed: 37778870
  53. Sievert M, Schuler G, Büttner K, Wehrend A. Comparison of different methods to determine the absorption of colostral IgG in newborn foals. J Equine Vet Sci 2022;114:104008.
    pubmed: 35577108
  54. Levy MM, Fink MP, Marshall JC. SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med 2003:1250‐1256.
    pubmed: 12682500
  55. Singer M, Clifford D, Seymour C. The third international consensus definitions for sepsis and septic shock (Sepsis‐3). JAMA 2016;315(8):801‐810.
    pmc: PMC4968574pubmed: 26903338
  56. Cortellini S, DeClue AE, Giunti M. Defining sepsis in small animals. J Vet Emerg Crit Care 2024;34(2):97‐109.
    pubmed: 38351524
  57. Lamy B, Dargère S, Arendrup MC, Parienti JJ, Tattevin P. How to optimize the use of blood cultures for the diagnosis of bloodstream infections? A state‐of‐the art. Front Microbiol 2016;7:697.
    pmc: PMC4863885pubmed: 27242721
  58. Delanghe JR, Speeckaert MM. Translational research and biomarkers in neonatal sepsis. Clinica Chimica Acta 2015;451:46‐64.
    pubmed: 25661089
  59. Bindi F, Vernaccini M, Bonelli F, Nocera I, Fanelli D, Sgorbini M. Apgar score, clinical, hemato‐biochemical, and venous blood gas parameters in a cohort of newborn mule foals: preliminary data. J Equine Vet Sci 2023;1:130.
    pubmed: 37696367
  60. Carr EA. Field triage of the neonatal foal. Vet Clin North Am Equine Pract 2014;30:283‐300.
    pmc: PMC7135403pubmed: 25016492
  61. Galvin N, Collins D. Perinatal asphyxia syndrome in the foal – review and a case report. Ir Vet J 2004;57(12):707‐714.
    pmc: PMC3113818pubmed: 21851654
  62. Ostermann M, Sprigings D. The critically ill patient. In: Sprigings D, Chambers JB, eds. Acute Medicine: A Practical Guide to the Management of Medical Emergencies. 5th ed. New Jersey, US: Wiley & Sons; 2017:1‐8.
  63. Toribio RE. Equine neonatal encephalopathy: facts, evidence, and opinions. Vet Clin North Am Equine Pract 2019;35:363‐378.
    pubmed: 31088699

Citations

This article has been cited 1 times.
  1. Kosaruk W, Punyapornwithaya V, Ueangpaiboon P, Angkawanish T. Classification of Clinical Outcomes in Hospitalized Asian Elephants Using Machine Learning and Survival Analysis: A Retrospective Study (2019-2024). Vet Sci 2025 Oct 16;12(10).
    doi: 10.3390/vetsci12100998pubmed: 41150138google scholar: lookup
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