Uncertain Outcome Research Articles

Primary ventriculitis caused by Streptococcus intermedius - a rare case and challenge with uncertain clinical outcome. Case report.

To present a case of primary ventriculitis in a 53-year-old patient caused by Streptococcus intermedius, emphasizing the rarity of the condition and the challenges in achieving clinical improvement despite targeted therapy. The patient underwent clinical evaluation, including CT and MRI imaging, as well as CSF analysis. Empirical antibiotic therapy was initiated with cefotaxime and metronidazole, followed by targeted therapy based on CSF culture results. External ventricular drainage was performed surgically. No predisposing factors were identified in the patient. Initial imaging showed no acute changes, but follow-up imaging revealed significant ventricular inflammation. CSF analysis confirmed the presence of Streptococcus intermedius. Despite early and targeted antibiotic therapy, and surgical intervention, the patient's clinical condition did not improve. This case highlights the rarity of primary ventriculitis caused by Streptococcus intermedius and the challenges in managing it. The lack of clinical improvement despite prompt and targeted treatment underscores the need for further research to develop more effective therapeutic strategies for such infections.

‘Dear guest, pay for your language’. How accommodation rating and ownership effect language presence on the Online Linguistic Landscape

Abstract The present paper draws on the concept of Online Linguistic Landscape (Kallen, Ní Dhonnacha & Wade, 2020) to explore code preference on hospitality websites at international tourist destinations. The analysis of a purpose-made database comprising the websites of all 254 accommodation establishments in Palma (Mallorca, Spain) reveals that although major tourist markets condition code presence on websites, the wide array of languages displayed does not correspond to the narrower catalogue of visiting nationalities. Beyond the strictly informative, websites have become effective promotion and sales tools, and marketability derived from vogue associations may mean that a language is listed on a website, even when other, more frequent guest languages are not. The scant online presence of Catalan, the autochthonous language of Mallorca, illustrates how, in mass tourism environments, minority languages are at the crossroads of succumbing to the demands of the market or submitting to processes of commodification of uncertain outcome.

Observing systemic values in a tax avoidance environment: Using systems theory to examine the Ireland–Apple tax relationship

AbstractTax has been the site of many battles between ethical behaviour and formal compliance with tax law, particularly in an international context. This paper accepts the functional differentiation of society and explores the amorality of systems. The environmental noise about unfair tax competition by states and tax avoidance by multinational enterprises is extensive. The autopoietic legal system cannot be relied upon to deliver a concurring view, instead producing its self‐referential and sometimes contradictory communications. The empirical setting considers Ireland and Apple and the legal system's verdict on the legality of their tax relationship. This legal verdict changes as the case progresses from European Commission to one court after another, a contingent and uncertain outcome that may be prompted by systemic irritation but which is not co‐ordinated with moral commentary on Ireland or Apple. The absence of coordination by the legal system with environmental commentary on fairness means that, as the legal verdict changes from court to superior court, moral commentary is not a reliable predictor of legal outcome.

The impact of violations of expected utility theory on choices in the face of multiple risks

Use of preference information to infer risk tolerance has increased in recent years as a way to inform benefit-risk evaluations in regulatory and medical decision making. However, a framework for the measurement of tolerance for multiple uncertain outcomes has not been formalized when choices do not comply with expected utility theory (EUT). We developed a formal analytic framework for the measurement of preferences through choices under uncertainty with multiple risks. Based on the analytic framework, we find that violations of EUT can lead to interaction effects between uncertain outcomes, not just nonlinearities in the disutility of risks. Our framework also implies that measures of risk tolerance derived from utility, such as maximum-acceptable risk, must consider all relevant risks jointly if their effect on choices is expected to violate EUT. Somewhat reassuringly, however, we find that cross-outcome effects are expected to be negligible when the probabilities of other outcomes approach certainty. Finally, we identify a simple test that can help evaluate whether preferences for one uncertain outcome are affected by other uncertain outcomes.

Uncertainty moderates the emotional consequences of reappraisal, social sharing, and rumination in daily life.

People must often wait for important but uncertain outcomes, like medical results or job offers. During such uncertain waiting periods, there is uncertainty around an outcome that people have minimal control over. Uncertainty makes these periods emotionally challenging, raising the possibility that emotion regulation strategies may have different effects while people wait for an uncertain outcome versus after they learn that outcome. To test this possibility, we conducted secondary analyses of an experience sampling study following 101 Belgian University students for 9 days as they waited for (uncertain period), and then received (certain period), consequential exam grades. Across 8,275 observations, we tested the effects of six emotion regulation strategies on positive and negative emotions about anticipated, and then actual, grades. Regardless of uncertainty, acceptance was consistently beneficial for short-term emotional well-being, and expressive suppression was consistently detrimental. However, the consequences of rumination, social sharing, and reappraisal differed when the outcome was uncertain versus certain. Rumination was more detrimental to short-term emotional well-being during the uncertain than certain period, while social sharing and reappraisal were detrimental in the uncertain period but beneficial in the certain period. These findings suggest uncertainty moderates the short-term effectiveness of some emotion regulation strategies in an academic context, which may exacerbate the emotional challenges of uncertain waiting periods. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Cryptocurrency Trading, Day Trading, and Gambling Behavior: Examining the Moderating Effects of Financially Focused Self-Concept and Gambling Motives.

Cryptocurrency and day trading have grown in popularity over the past decade following the creation of the first cryptocurrency, Bitcoin, in 2009. These activities share important features with gambling, including risking money on an uncertain outcome, a chance of monetary rewards, and the potential to experience harm (e.g., financial or relationship problems). However, little is known about cryptocurrency and day trading engagement in the adult population, including associations with gambling behavior, harm, and psychological factors that might moderate these relationships. We analyzed cross-sectional data for n = 822 adults from an online panel in the U.S. to examine: (1) the extent to which cryptocurrency trading, day trading, and gambling are associated, (2) relationships between cryptocurrency trading, day trading, and higher risk gambling behavior, and (3) whether financially focused self-concept and four types of gambling motives moderate these relationships. We found moderate to strong positive intercorrelations between cryptocurrency and day trading, and gambling behavior, including engagement and risk. We identified significant moderating effects of financially focused self-concept, and coping motives for gambling, on the relationship between cryptocurrency trading and gambling frequency, and between day trading and gambling frequency. For the models predicting higher risk gambling status, the only significant moderators were financially focused self-concept for the day trading model, and the enhancement motive for the cryptocurrency and day trading models. Our results have important implications for understanding interrelationships between gambling-adjacent activities and more traditional gambling forms, as well as the moderating roles of key psychosocial concepts in these relationships.

Obstetrical attitude towards performing a trial of labor after cesarean section in Greece: A cross-sectional study

Introduction: There has been a notable worldwide rise in the percentage of women delivering via cesarean section. Although cesarean section is generally considered safe, there is a possibility of significant health risks and even mortality associated with it. The aim of this study was to collect pertinent data on the perspectives of healthcare providers, particularly obstetricians, who are involved in the field of labor and delivery in Greece, regarding the choice of Trial Of Labor After Cesarean (TOLAC). Material and Methods: This was a cross-sectional study, conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece; obstetricians were interviewed via certain questionnaires. Detailed analysis of the different characteristics regarding obstetricians’ background, workplace, preferences, willingness to take risks and safety concerns was conducted. These variables were compared and correlation between them was thoroughly investigated. Results: In total, 333 responses to the questionnaire were collected through Google online forms. Few obstetricians seem to enjoy taking risks, while most of them are neutral and willing to perform a planned TOLAC. It seems that as the experience of obstetricians increases, their tendency to recommend TOLAC on their own does not increase. The majority of obstetricians who had a failed TOLAC were more negative than those who had not had a failed attempt; whereas, they were willing to undertake TOLAC when the time required to transfer the women from the labor ward to the operating table was the minimum possible. Concerning the security as an important element in every aspect of obstetricians’ lives, the majority of them responded neutrally or positively. Following gender analysis, results showed that both male and female obstetricians were neutral or would avoid situations that have an uncertain outcome. Conclusion: Obstetricians and healthcare providers are willing to offer TOLAC as an option, provided that certain criteria are met and safety considerations are addressed. Finally, the acceptance and practice of TOLAC may vary between different regions, hospitals and individual healthcare providers.

International Perspectives of Extended Genetic Sequencing When Used as Part of Newborn Screening to Identify Cystic Fibrosis.

There is increasing interest in using extended genetic sequencing (EGS) in newborn screening (NBS) for cystic fibrosis (CF). How this is implemented will change the number of children being given an uncertain outcome of CRMS/CFSPID (cystic fibrosis transmembrane conductance regulator (CFTR)-related metabolic syndrome/CF Screen Positive Inconclusive Diagnosis), probable carrier results, and the number of missed CF diagnoses. An international survey of CF health professionals was used to gather views on two approaches to EGS-specific (may reduce detection of CRMS/CFSID but miss some CF cases) versus sensitive (may increase detection of CRMS/CFSPID but avoid missing more CF cases). Health professionals acknowledged the anxiety caused to parents (and health professionals) from the uncertainty surrounding the prognosis and management of CRMS/CFSPID. However, most preferred the sensitive approach, as overall, identifying more cases of CRMS/CFSPID was viewed as less physically and psychologically damaging than a missed case of CF. The importance of early diagnosis and treatment for CF to ensure better health outcomes and reducing diagnostic odysseys for parents were highlighted. A potential benefit to identifying more children with CRMS/CFSPID included increasing knowledge to obtain a better understanding of how these children should best be managed in the future.

Exploring Parent Experiences With Early Palliative Care Practices in the NICU.

The anxiety and uncertain outcome of an admission of a seriously ill infant to the neonatal intensive care unit (NICU) can cause great stress for parents and contribute to poor mental health outcomes. Early implementation of family-centered palliative care (PC) may provide support for NICU parents. Key concepts of early PC in the NICU include shared decision-making, care planning, and support for coping with distress. The purpose of this study was to explore parent experiences during their child's NICU admission with the early PC practices of shared decision-making, care planning, and coping with distress. Qualitative descriptive methodology was used. Strategies of reflexive journaling, peer debriefing, and data audits were used to enhance trustworthiness. Parents (N = 16) were interviewed, and data were analyzed by conventional content analysis. Targeted recruitment of fathers occurred to ensure they comprised 25% of sample. Parents' descriptions of decision-making were contextualized in gathering information to make a decision, the emotional impact of the decision, and influences on their decision-making. In experiences with care planning, parents described learning to advocate, having a spectator versus participant role, and experiencing care planning as communication. Key themes expressed regarding parental coping were exposure to trauma, survival mode, and a changing support network. These findings highlight key areas for practice improvement: providing more support and collaboration in decision-making, true engagement of parents in care planning, and encouraging peer support and interaction in the NICU and in online communities.

Bayesian Mendelian randomization with an interval causal null hypothesis: ternary decision rules and loss function calibration

We enhance the Bayesian Mendelian Randomization (MR) framework of Berzuini et al. (Biostatistics 21(1):86–101, 2018) by allowing for interval null causal hypotheses, where values of the causal effect parameter that fall within a user-specified interval of “practical equivalence” (ROPE) (Kruschke, Adv Methods Pract Psychol Sci 1(2):270–80, 2018) are regarded as equivalent to “no effect”. We motivate this move in the context of MR analysis. In this approach, the decision over the hypothesis test is taken on the basis of the Bayesian posterior odds for the causal effect parameter falling within the ROPE. We allow the causal effect parameter to have a mixture prior, with components corresponding to the null and the alternative hypothesis. Inference is performed via Markov chain Monte Carlo (MCMC) methods. We speed up the calculations by fitting to the data a simpler model than the intended, "true", one. We recover a set of samples from the “true” posterior distribution by weighted importance resampling of the MCMC-generated samples. From the final samples we obtain a simulation consistent estimate of the desired posterior odds, and ultimately of the Bayes factor for the interval-valued null hypothesis, H0\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$H_0$$\\end{document}, vs H1\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$H_1$$\\end{document}. In those situations where the posterior odds is neither large nor small enough, we allow for an uncertain outcome of the test decision, thereby moving to a ternary decision logic. Finally, we present an approach to calibration of the proposed method via loss function. We illustrate the method with the aid of a study of the causal effect of obesity on risk of juvenile myocardial infarction based on a unique prospective dataset.

Shaping a Modern Townscape in The City Centre Area: The Case of Vilnius

Abstract The development of a contemporary townscape within the historical urban structures is a phenomenon of this period that has been going on in Lithuania for about 20 years. This is an ongoing process with an uncertain outcome, as the rapidly changing urban design trends require quick responses to current needs. It is necessary to modify, revise, and supplement the concepts and existing legislation accordingly. This article examines the factors leading to the emergence and formation of the modern townscape in Vilnius, as well as the documents governing the city’s development after gaining independence. It presents an evaluation of the newly established urban structures in the central part of Vilnius and identifies the challenges and problems in shaping the contemporary townscape. The results of the study allow us to identify what actions must be taken in order to form a high-quality modern townscape, starting with self-evaluation of what has been done and ending with the creation of a dynamic urban model that would respond to constantly changing needs.

Model parameter influence on probabilistic flood risk analysis

Flood risk models are critical for effective evidence-based flood management interventions. Risk models typically analyse flood hazards, elements (e.g., buildings) exposed, and their susceptibility to monetary losses. These model parameters are inherently uncertain and their interactions within a risk model create an uncertain loss outcome. This study constructed an object-level probabilistic flood risk model for Westport (New Zealand) to analyse parameter uncertainty and sensitivities for residential building monetary loss prediction. Several model parameter combinations were assessed: 1) water depth spatial sampling method, 2) replacement valuation method, and 3) univariable and multivariable vulnerability model. Monetary loss uncertainty was analysed using test models that varied parameter combinations. Sensitivity to parameter uncertainty distributions were assessed using a global sensitivity analysis based on Sobol's method. Monetary loss estimates ranged between ± NZD 1 million to ± NZD 6 million (90 % confidence interval) for test models by varying parameter combinations. Loss estimates ranged from 2 % to 100 % across the analysed test models. Replacement valuation and vulnerability models were the primary drivers of loss uncertainty. Sobol first-order indices confirmed vulnerability models had the largest parameter influence on uncertainty while total-order indices showed replacement value has a larger overall contribution. The study outcomes emphasise flood risk modellers' need to investigate model uncertainties to inform accuracy improvement solutions.

Effects of Virtual Reality on Pain, Anxiety, Patient Satisfaction in Coronary Angiography: A Randomized Trial

BackgroundSince patients are conscious during the coronary angiography procedure, they may experience pain and anxiety regarding possible complications and an uncertain outcome. AimThis study was conducted to determine the effects of virtual reality application on pain severity, anxiety level, and patient satisfaction in patients who undergo coronary angiography. MethodThis randomized controlled study was conducted with a total of 70 patients, including 35 patients in the intervention and 35 patients in the control group. Apart from their routine treatment, virtual reality glasses application was used in the intervention group patients during the procedure. The patients in the control group were given only routine treatment. Data were collected by using “Descriptive Information Form”, “Visual Analogue Scale (VAS)”, Anxiety Assessment Scale (AAS), “Physiological Symptoms of Anxiety Follow-up Form”, and “Virtual Reality Glass Application Satisfaction Form”. ResultsMean post-intervention scores of VAS, AAS, heart rate, diastolic and systolic blood pressure, respiratory rate of the intervention group decreased significantly compared with the control group, while O2 saturation value was found to increase significantly. ConclusionsIn this study, it was found that virtual reality application was effective in reducing pain and anxiety, increasing patient satisfaction, and normative regulation of vital signs in patients who undergo coronary angiography.

Abstract 353: The Uncertainty Principle in Cardiac Arrest and Critical Care Trials

Introduction: A challenge with clinical trials is the capacity to identify a population that may potentially benefit from the intervention that is not “too well” (will recover) or “too sick” (will not survive) regardless of intervention. While inclusion criteria attempt to obtain this, populations enrolled in trials include pts in which bedside clinicians would be able to categorize in terms of likelihood of survival independent of study intervention. We further hypothesize that patients categorized as having an uncertain outcome would be most likely to benefit from the intervention. Methods: We present subgroup analyses of patients from the Thiamine as a Metabolic Resuscitator in Cardiac Arrest (THACA) trial in patients with out of hospital cardiac arrest and the Ascorbic Acid, Corticosteroids and Thiamine in Sepsis (ACTS) trial in patients with septic shock. The treating physician predicted at the time of enrollment whether the patient is “very likely”, “very unlikely”, or ”uncertain” to be alive at 30 days. Results: Among 31 pts in the THACA trial with physician predictions, 12/31 (39%) were predicted very unlikely to be alive on day 30, 3/31 (10%) very likely, and 16/31 (52%) uncertain. Among 200 pts in the ACTS trial, 13/200 (7%) of patients were predicted as very unlikely, 72/201 (36%) very likely and 115/201 (57%) uncertain. Predicted mortality was associated with observed mortality in both trials(p = 0.04, p<0.001). When evaluating the primary outcome in the population categorized as uncertain, there was a non-significant shift in favor of the intervention in THACA (p = 0.69); and a difference favoring the intervention in ACTS (p = 0.03) as opposed to the overall cohort which did not reach statistical significance (p = 0.12). Conclusion: In two RCTs in patients with cardiac arrest and septic shock, physicians reliably predicted mortality. Restricting analyses to pts with an uncertain outcome, the primary outcome in one trial changed from trending toward favoring the intervention to a statistically significant difference. The second trial shifted in favor of the outcome but did not reach statistical significance. These findings suggest that physician prediction may be a potential method to target patients with the greatest chance to benefit from clinical trials.

Systematization of industrial technogenic risks at mining enterprises

Research objective is to develop a general approach to systematizing the signs of mining territories, natural and man-made features safety. Research relevance is due to the need to ensure the safety of economic activity in the territory of mining. Methods of research. Subsoil use implies taking into account multiple factors that lead to the risk of decisions implementation. Risk is considered as a potential, numerically estimated probability of the unfavorable events (situations), their consequences in the form of accidents, human casualties, losses, damages, material losses, etc. Risk is a quantitative assessment of the hazards characterizing a situation with uncertain outcome and obligatory manifestation of unfavorable consequences. It is advisable to assess the safety status of any mining enterprise site by a number of indicators that characterize the system’s resilience to negative impacts caused by infrastructural, natural, geological, technological, economic and financial factors. The risk situation caused by statistical processes is associated with accompanying conditions: the presence of uncertainty, the need for an alternative choice, and the possibility of accepted options (alternatives) probabilistic evaluation. Negative phenomena in subsoil use are manifested in the form of deformation of pit walls and dumps, collapse of an individual or a group of pit benches, destruction of transport lines and power supply utilities, rockfall, beneficiation process flow deviations from the designed one, violations of man-made features and the ecological and biological environment, which should be interpreted as man-made disasters of an industrial nature. Results. The classification of risks as a multidimensional category is justified by the factors (causes) of occurrence, the driving force of which generates a negative process and determines its characteristics or individual features. Conclusions. The systematization of various risks based on infrastructural, mining-geological, process flow and environmental factors ensures, at the initial stage of risk formation, the determination of their characteristics and the development of a system of management measures to ensure the sustainable functioning of a mining enterprise.

Assessment of listing and categorisation of animal diseases within the framework of the Animal Health Law (Regulation (EU) No 2016/429): infectious pancreatic necrosis (IPN).

Infectious pancreatic necrosis (IPN) was assessed according to the criteria of the Animal Health Law (AHL), in particular, the criteria of Article 7 on disease profile and impacts, Article 5 on its eligibility to be listed, Annex IV for its categorisation according to disease prevention and control rules as in Article 9, and Article 8 for listing animal species related to IPN. The assessment was performed following a methodology previously published. The outcome reported is the median of the probability ranges provided by the experts, which indicates whether each criterion is fulfilled (lower bound ≥ 66%) or not (upper bound ≤ 33%), or whether there is uncertainty about fulfilment. Reasoning points are reported for criteria with an uncertain outcome. According to the assessment here performed, it is uncertain whether IPN can be considered eligible to be listed for Union intervention according to Article 5 of the AHL (50-90% probability). According to the criteria in Annex IV, for the purpose of categorisation related to the level of prevention and control as in Article 9 of the AHL, the AHAW Panel concluded that IPN does not meet the criteria in Section 1 (Category A; 0-1% probability of meeting the criteria) and it is uncertain whether it meets the criteria in Sections 2, 3, 4 and 5 (Categories B, C, D and E; 33-66%, 33-66%, 50-90% and 50-99% probability of meeting the criteria, respectively). The animal species to be listed for IPN according to Article 8 criteria are provided.

Assessing the impact of waste separation on system transition and environmental performance through a city-scale life cycle assessment

The increase in municipal solid waste (MSW) generation entails growing pressures on developing countries to achieve urban sustainability. New waste management strategies should be implemented with caution considering limited budget and uncertain outcome. Taking the city of Shenzhen, China as a case study, this research aimed to assess the positive transition of this city's MSW management system since the recent enforcement of waste separation. The life cycle assessment (LCA) results confirmed a good synergy between waste management system upgrade and environmental performance improvements. A noteworthy reduction of 51% in Global Warming Potential (GWP) was observed with determined cost of 61 US$/t CO2-eq, making waste separation a cost-effective management option for developing economies to achieve their environmental targets. Sensitivity analysis was performed to address the effect of specific waste composition and related properties on systematic environmental performance. Results emphasized the impact of a certain waste treatment pathway is not always constant therefore characterization of local waste flow is vital to facilitate integrated waste management. Municipalities from developing countries are encouraged to take mandatory separation as a first step to upgrade insufficient waste management system before heavy investment in new treatment technologies.

Spillover effects of competition outcome on future risky cooperation

There is growing evidence that risky cooperation is regulated by the experience of previous interactions with others. However, it is unclear how the evaluation of outcomes from competitive interactions can affect individuals’ subsequent cooperative behavior. To address this issue, we examined how participants cooperated with a partner having just competed with them. While competing, participants (N = 164) were randomly assigned to receive one of four types of outcome feedback regarding their performance (victory vs. defeat vs. uncertain vs. no competition (control)). We found that both the experience of defeats and of uncertainty as competitive outcomes exerted a negative impact on the extent to which participants then engaged in cooperative behavior with their recent opponents. This only occurred when such subsequent cooperative behavior involved a high potential for incurring personal costs but not when there was no risk of incurring personal costs and a positive return. Finally, mediation analysis revealed that the effect of defeat was mediated by participants’ level of interpersonal trust and the extent to which participants were willing to cooperate, while the effect of the uncertain competitive outcome was mediated only by the extent to which participants were willing to cooperate. These findings offer novel insights into how risky cooperation is modulated by previous competition.

Perennial crisis and the loss of flexibility

Crisis interrupts routine in unwelcome ways with an uncertain outcome. The Greek word krisis (κρíσις), which is etymologically close to criterion and criticism, was occasionally used in relation to social ailments. However, more often, it was used to refer to a medical condition characterized by a high fever. A critical condition in English and other European languages refers to a similar situation. Two possible outcomes were envisioned in ancient Greece: you died or you recovered. In the contemporary world, the term ‘crisis’ can be of limited relevance since crisis is endemic and chronic in one or several domains virtually everywhere. There are two general causes for this: accelerated, runaway globalization generates unpredictable, unintentional side effects; and different parts of a lifeworld change at different speeds, leading to disjunctures and destabilization. Perhaps volatility is a more appropriate term.

IRIS-Stage 4 CKD in a Dog: Diagnostic Approaches and Staging of Chronic Kidney Disease: A Case Study

Chronic kidney disease (CKD) is a devastating disease of the kidneys that often arise from unresolved acute injury. As a chronic disease, CKD is challenging to diagnose, thus it needs a good combination of a comprehensive understanding of the kidney’s anatomy and physiology and thorough planning for a framework of diagnostic tools to be utilized. This study is intended to provide the diagnostic planning used to determine CKD in an approximately 5-year-old intact male dog that was brought to My Vets Animal Clinic for a check-up visit. On presentation, the dog was emaciated, mildly dehydrated, halitotic, and infested with ticks. A complete blood count (CBC) indicated a normocytic, normochromic, non-regenerative anemia, and lymphopenia. The blood chemistry panel indicated azotemia, elevated symmetric dimethylarginine (SDMA), hypocalcemia, and hyperphosphatemia. Elevated SDMA level (64 μg/dL, reference value: 0-14 μg/dL) and hypercreatinemia (5.9 mg/dL, reference value: 0.5-1.8 mg/dL) indicated impaired glomerular filtration. Physical and clinical pathological findings signified the presence of CKD in this dog, with a stage-4 severity based on International Renal Interest Society (IRIS) CKD staging criteria. The prognosis of this case was highly guarded, and the dog eventually passed away on the sixth day of hospitalization. In a case with an uncertain outcome, accuracy in both diagnosis and staging of CKD in dogs will aid the therapy regimen planning, which may improve the patient’s conditions.