Abstract
Septic peritonitis (SP) is common in dogs and is associated with high mortality. Early recognition is essential to maximizing survival and may be aided by biomarker measurement. The present study aimed to evaluate the ability of biomarkers to discriminate septic peritonitis from non-septic ascites (NSA). Eighteen dogs with SP and 19 age-matched controls with NSA were enrolled. Contemporaneous blood and peritoneal effusion samples were obtained. Concentrations of cell-free DNA (cfDNA), cytokines, glucose, lactate, N-terminal pro-C-type natriuretic peptide (NT-proCNP), nucleosomes, and procalcitonin (PCT) were measured using commercial reagents and assays. Paired biomarker concentrations were compared with the Wilcoxon matched-pairs signed rank test, and biomarker concentrations between groups were compared with the Mann-Whitney U-test. P-values were adjusted for multiple comparisons using the Bonferroni correction. Receiver operating characteristic curves were generated to assess the ability of the above biomarkers to discriminate SP from NSA. Dogs with SP had significantly greater blood CCL2 concentrations than dogs with NSA (P = 0.032). Dogs with SP had significantly greater effusion CCL2, IL-6, IL-10, and lactate concentrations than dogs with NSA (P ≤ 0.0121). Blood-effusion concentration gradients of CCL2, glucose, IL-6, IL-10, and lactate were significantly different in dogs with SP compared to dogs with NSA (P ≤ 0.0165). Effusion lactate concentration had the highest AUROC value (0.866, 95% CI 0.751–0.980, P = 0.0001), although other biomarkers performed similarly. An effusion lactate concentration of 4.2 mmol/L was 72.2% (95% CI 46.5–90.3%) sensitive and 84.2% (95% CI 60.4–96.6%) specific for the diagnosis of SP.
Highlights
Septic peritonitis (SP) is inflammation of the peritoneal cavity caused by the presence of viable bacteria, and is a surgical emergency [1]
Dogs were eligible for inclusion if they satisfied at least 2 of 4 systemic inflammatory response syndrome (SIRS) criteria [49], and had peritoneal effusion identified using point-of-care ultrasonography performed according to established protocols [50, 51]
Differentiating SP from non-septic ascites (NSA) can be challenging as many of these patients have similar presenting complaints, clinical examination abnormalities, and clinicopathological findings
Summary
Septic peritonitis (SP) is inflammation of the peritoneal cavity caused by the presence of viable bacteria, and is a surgical emergency [1]. Diagnosis can be challenging when bacterial numbers are low, such as with gastric perforation [7, 8], when the volume of effusion is small and when prior diagnostic or therapeutic interventions reduce bacterial counts [1]. In such patients, laboratory biomarkers specific to sepsis that can be rapidly measured might offer high diagnostic accuracy and be faster than bacterial culture techniques [9, 10]
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