Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals.
Abstract: Serum amyloid A (SAA) has been reported to hold promise as diagnostic and prognostic marker in foals. This has not been investigated thoroughly. Objective: Evaluate admission SAA concentrations as predictor of sepsis and outcome. Methods: Five hundred and ninety hospitalized foals <14 days old. Methods: Retrospective multicenter study. Foals were scored with sepsis and survival scores, grouped according to health category (septic, sick but nonseptic, uncertain sepsis status) and outcome; septic foals were further categorized according to severity (normal sepsis, severe sepsis, and septic shock). SAA was compared between groups using Mann-Whitney test and Kruskal-Wallis test. Receiver operating characteristic curves identified optimal SAA cut off values for detecting sepsis and predicting outcome. Results: Admission SAA concentrations differed significantly between sick nonseptic foals (312.1 ± 685.4 mg/L) and septic foals (1079.7 ± 1254.5 mg/L) and increased with increasing sepsis score. SAA did not differ between sepsis severity groups. The optimal cut off for sepsis detection was 1050 mg/L (sensitivity 30.2%, specificity 90.7%). Admission SAA concentrations were lower in surviving (435.0 ± 723.6 mg/L) compared to nonsurviving foals (1062.7 ± 1440.1 mg/L) and decreased with increasing survival score. The optimal cut off for nonsurvival prediction was 1250 mg/L (sensitivity 22.1%, specificity 90.8%). Conclusions: SAA concentration was higher in septic foals and nonsurviving foals. Even though optimal cut offs for SAA to detect sepsis and predict outcome had low sensitivity, they had good specificity. SAA can therefore be used as a marker to rule out sepsis and nonsurvival.
© 2022 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals LLC on behalf of American College of Veterinary Internal Medicine.
Publication Date: 2022-10-14 PubMed ID: 36239317PubMed Central: PMC9708439DOI: 10.1111/jvim.16550Google Scholar: Lookup
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- Multicenter Study
- Journal Article
Summary
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This research article focuses on the use of Serum Amyloid A (SAA) as a potential diagnostic and prognostic marker for sepsis and outcome prediction in neonatal foals. More specifically, it examines the correlation between the admission concentrations of SAA in septic and non-septic foals and their survival rates, to establish optimal cut-off SAA values.
Objective and Methods
The primary aim of this study was to evaluate the use of SAA concentration at the time of admission as a predictor of sepsis in neonatal foals and the likely outcome. The research was conducted on 590 foals aged less than 14 days who were hospitalized. The method was a retrospective multicenter study, meaning prior patient data across various centers was analyzed.
Using the sepsis and survival scores, the foals were grouped based on their health condition into three categories:
- Septic
- Sick but non-septic
- Uncertain sepsis status
Septic foals were further categorized according to sepsis severity into normal sepsis, severe sepsis, and septic shock. Statistical tests such as Mann-Whitney test and Kruskal-Wallis test were applied to compare SAA between groups.
Results
The study found a significant difference in the SAA concentrations between the sick non-septic foals and the septic ones, with the latter having much higher concentrations. SAA concentrations also increased in line with the increase in the sepsis score, but no major difference was observed among the sepsis severity groups.
The optimal cut-off value for the diagnosis of sepsis was revealed to be 1050 mg/L, which yielded a sensitivity of 30.2% and a specificity of 90.7%. Basically, this means that of the foals with sepsis, about 30% would show a SAA level of 1050 mg/L or higher, and about 91% of the healthy foals would show SAA levels below this predicted value.
Additionally, the study found lower SAA concentrations in surviving foals when compared to the nonsurvivors. The optimal cut-off value to predict non-survival was established to be 1250 mg/L, with a sensitivity of 22.1% and specificity of 90.8%.
Conclusions
The study concluded that SAA levels were higher in septic foals and non-surviving foals. Since higher SAA concentration correlated with sepsis and lower survival rates, the study suggests that SAA can be effectively used as a marker to rule out sepsis and non-survival in neonatal foals. However, it should be noted that the sensitivity of these cut-off values was quite low, implying that the test may miss several positive cases. But they exhibit a good specificity implying a lower number of false positives, thus making it reliable to rule out absence of the condition.
Cite This Article
APA
Hoeberg E, Sånge A, Saegerman C, Bohlin A, Nostell K, Durie I, Husted L, Öhman A, Jacobsen S, Berg L, Laursen SH, van Galen G.
(2022).
Serum amyloid A as a marker to detect sepsis and predict outcome in hospitalized neonatal foals.
J Vet Intern Med, 36(6), 2245-2253.
https://doi.org/10.1111/jvim.16550 Publication
Researcher Affiliations
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.
- Faculty of Veterinary Medicine, Norwegian University of Life Sciences, Ås, Norway.
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden.
- Research Unit in Epidemiology and Risk Analysis Applied to Veterinary Sciences (UREAR-ULiege), Fundamental and Applied Research for Animal Health (FARAH) Center, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium.
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden.
- Swedish University of Agricultural Sciences, Uppsala, Sweden.
- Evidensia Equine Specialist Hospital Stromsholm, Stromsholm, Sweden.
- Højgaard Equine Hospital, Morud, Denmark.
- Evidensia Equine Specialist Hospital Helsingborg, Helsingborg, Sweden.
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.
- Equine Medical Consult, Hornbaek, Denmark.
- Medicine and Surgery, Department of Veterinary Clinical Sciences, University of Copenhagen, Taastrup, Denmark.
- Sydney School of Veterinary Science, Faculty of Science, The University of Sydney, Sydney, Australia.
MeSH Terms
- Horses
- Animals
- Serum Amyloid A Protein
- Animals, Newborn
- Horse Diseases
- Sepsis / diagnosis
- Sepsis / veterinary
- Biomarkers
Conflict of Interest Statement
Authors declare no conflict of interest.
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Citations
This article has been cited 6 times.- Vance JK, Lailler N, Divens AM, Povroznik JM, Annamanedi M, Brundage KM, Robinson CM. Interleukin-27-producing cells in gram-negative neonatal sepsis display diverse phenotypes and functions in the liver. Immunohorizons 2025 Jul 14;9(8).
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