Abstract
Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. The mortality rate was 22%. Classification tree analysis indicated that mortality was associated with clinical signs of neurologic disease, abdominal emergencies, cachexia, orthopedic problems such as septic arthritis, and profound acidemia (jugular venous blood pH < 6.85). When exclusively considering laboratory parameters, classification tree analysis identified plasma glucose concentrations < 3.2 mmol/L, plasma sodium concentrations ≥ 151 mmol/L, serum GGT activity < 31 U/L and a thrombocyte count < 535 G/L as predictors of mortality. However, multivariable logistic regression models based on these laboratory parameters did not have a sufficiently high enough sensitivity (59%) and specificity (79%) to reliably predict treatment outcome. The sensitivity and specificity of jugular venous blood pH < 6.85 were 11% and 97%, respectively, for predicting non-survival in this study population. We conclude that laboratory values (except jugular venous blood pH < 6.85) are of limited value for predicting outcome in critically ill neonatal calves with diarrhea. In contrast, the presence of specific clinical abnormalities provides valuable prognostic information.
Highlights
IntroductionSevere acidemia due to strong ion (metabolic) acidosis is associated with an increased mortality rate in critically ill human patients and is frequently associated with hyper-L-lactatemia
The presence of severe malnutrition, clinical dehydration, sepsis, pneumonia or respiratory distress, drowsiness, meningitis, abdominal distention, and absent peripheral pulses, as well as hypoglycemia, hypoxemia, hypoalbuminemia, hyponatremia and hypernatremia, have been identified as independent predictors of death in diarrheic children [28, 32,33,34,35]. These results suggest that the prognostic accuracy can be improved in diarrheic children when clinical signs are evaluated in combination with laboratory values, instead of basing prognosis only on the results of laboratory analysis
Our findings strongly suggest that prognosis in critically ill calves with diarrhea can be made more accurate by considering both clinical signs and laboratory values, and support the adage “treat the patient and not the laboratory value”
Summary
Severe acidemia due to strong ion (metabolic) acidosis is associated with an increased mortality rate in critically ill human patients and is frequently associated with hyper-L-lactatemia. Hemoconcentration, azotemia, hypoglycemia, hyponatremia, hyperkalemia, septicemia, hyper-Dlactatemia, hyper-L-lactatemia, and the development of a strong ion (metabolic) acidosis are well known complications of neonatal diarrhea in calves [7,8,9,10]. Acid-base and serum biochemical variables might provide clinically useful prognostic indicators in critically ill calves with diarrhea. Previous studies using small study populations of diarrheic calves identified hemoconcentration and increased serum urea, potassium and chloride concentrations as risk factors for death [11, 12], but these studies did not investigate the prognostic value of acid-base values such as blood pH or the plasma concentrations of glucose, D-lactate, and L-lactate, or the prognostic value of clinical findings
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