Development of a prognostic scoring system for systemic inflammatory response syndrome in donkeys.

BACKGROUND

Systemic inflammatory response syndrome (SIRS) is associated with increased mortality in horses with gastrointestinal (GI) disease. However, there are no data relating to naturally occurring SIRS in donkeys.

OBJECTIVES

To determine SIRS frequency in donkeys with GI disease. To develop a donkey-specific prognostic SIRS score.

STUDY

DESIGN

Retrospective case series.

METHODS

Clinical records from donkeys presenting with GI disease in two independent cohorts (development cohort: n = 400, UK; validation cohort: n = 36, Australia) were reviewed. Age, sex, heart rate, respiratory rate, rectal temperature, white blood cell count (WBCC), neutrophil%, neutrophil count, packed cell volume (PCV), total protein (TP), PCV/TP ratio, triglycerides, albumin, creatinine, urea, serum amyloid A, and outcome were recorded. SIRS scores validated for horses (hSIRS, 0-4) were calculated. Prognostic factors were identified in the development cohort using generalised estimating equations and receiver operator characteristic analysis. A novel donkey SIRS score (dSIRS, 0-6) was developed and applied to the second cohort for validation. A traffic light system was further devised to classify individuals as low-, medium-, and high-risk of non-survival.

RESULTS

In the development cohort, 32.1% cases fulfilled the hSIRS criteria. The fatality rate was 45.6% in these cases. Only two of the hSIRS criteria (heart rate >56 bpm; WBCC <5.2 or >13.8 × 109/L) were significant predictors of outcome. The dSIRS score included heart rate, WBCC, age (15-25; or >25 years), PCV/TP ratio (>0.5725), and [triglyceride] (>2.8 mmol/L). In the development cohort, the dSIRS score predicted outcome with 78.3% accuracy (sensitivity: 62.7% [95% CI: 51.9-72.3]; specificity: 83.5% [78.4-87.5]). In the validation cohort, accuracy was 81% (sensitivity: 100% [79.6-100.0], specificity: 47.6% [28.3-67.6]).

MAIN LIMITATIONS: Retrospective study, small validation cohort.

CONCLUSIONS

The frequency of SIRS and associated fatality rate in donkeys with GI disease is high. After further validation through a prospective study, the dSIRS score could be a valuable prognostic tool.