The Prognostic Utility of Degenerative Left Shifts in Dogs

Abstract

A degenerative left shift (DLS) in dogs is reported to be a poor prognostic indicator, but no studies have been reported to verify this claim. To characterize the canine population affected by DLS and to determine if the presence and severity of the DLS are associated with increased risk of euthanasia or death. Three-hundred and nineteen dogs with DLS (cases) and 918 dogs without DLS (controls) presented to the University of California, Davis Veterinary Medical Teaching Hospital between April 1, 1995 and April 1, 2010. Retrospective case-control study. All cases had a CBC performed within 24 hours of presentation that showed an immature neutrophil count higher than the mature neutrophil count. Controls were matched by year of presentation and primary diagnosis. Survival analysis was used to determine the risk of death or euthanasia associated with DLS and other potential predictors. Half of cases versus 76% of controls were alive at discharge. Median in-hospital survival time was 7 days for cases and 13 days for controls. DLS was a significant predictor of death or euthanasia in both univariate and multivariate analysis (hazard ratio, HR, 1.9; 95% CI 1.54-2.34). DLS in dogs is associated with an increased risk of death or euthanasia. This finding, however, varies with disease diagnosis and should be interpreted in light of the individual patient.