Background: Neutrophil gelatinase-associated lipocalin (NGAL) and tissue inhibitor of metalloproteinase-2 (TIMP-2) have potential as early biomarkers for acute kidney injury (AKI) in dogs. Objectives: Assess whether NGAL and TIMP-2 at admission (T0) and 24 h later (T1) identify survival in critically ill (CI) and AKI dogs, development of hospital-acquired AKI in CI dogs, and development of chronic kidney disease (CKD) in AKI dogs after 3 months. Animals: Sixty-two client-owned dogs: 10 healthy, 24 with AKI, and 28 CI. Methods: Prospective study with blood and urine samples collected at T0, T1, and up to 1 week in CI dogs, 1 month in healthy dogs, and 3 months in AKI dogs. Serum and urinary NGAL (sNGAL; uNGAL) and urinary TIMP-2 (uTIMP-2) were measured using validated ELISA kits. Results: Dogs with AKI that did not survive had significantly higher uNGAL concentrations and u/sNGAL ratios at T0 compared with survivors (p = 0.05, n = 23; and p = 0.03, n = 21, respectively). In CI dogs, sNGAL was significantly higher in non-survivors at T0 and T1 compared with survivors (p = 0.02, n = 26; and p = 0.003, n = 26, respectively). At T0, normalized urinary tissue inhibitor of metalloproteinase-2 (unormTIMP-2) was significantly higher in non-survivor CI dogs compared with survivors (p = 0.04, n = 25). No significant differences were found for the other variables. Conclusions and Clinical Relevance: In AKI dogs, uNGAL and u/sNGAL at T0, and in CI dogs, sNGAL at T0 and T1 and unormTIMP-2 at T0, were potential predictors of survival.

Background: The care of sick neonatal foals is labor-intensive and costly. Prediction of risk of death upon admission is often difficult but might support decision-making. Objectives: To determine diseases and risk factors associated with death in neonatal hospitalized foals. Animals: Two hundred twenty-two hospitalized foals, ≤7 days old. Methods: Retrospective cohort study. Clinical and laboratory variables were evaluated for their association with death by means of Cox survival analysis and by classification and regression tree (CART) analysis. Results: Most prevalent diseases were sepsis (43.9%), enteritis (14.0%), and omphalitis (9.0%). Case fatality rate was 33.3%. Neonatal sepsis significantly increased the risk of death (hazard ratio [HR] = 1.9; 95% confidence interval [CI] = 1.2-3.0; P = .009). Multivariable Cox regression in foals ≤7 days old revealed comatose mental state (HR = 2.9; 95% CI = 1.1-8.1; P = .04), L-lactatemia (≥373.8 mg/L [4.2 mmol/L]; HR = 4.4; 95% CI = 1.7-11.7; P = .003) and increased serum amyloid A (SAA; ≥2054 μg/mL; HR = 3.9; 95% CI = 1.2-12.7; P = .02) as risk factors for death, with a sensitivity and specificity of 7.5% and 95.7%, respectively. The CART analysis highlighted L-lactatemia, comatose mental state, and hypercapnia as risk factors for death, with a sensitivity of 38.1% and specificity of 86.1% after validation. Conclusions and Clinical Importance: In this study sample, sepsis was associated with the highest risk of death. Identified risk factors such as SAA, L-lactate, and comatose mental state might guide veterinarians and owners in better decision-making for economic or welfare reasons. Frequently measured laboratory variables, such as blood glucose concentration and Immunoglobulin G, were not sensitive and specific enough to provide reliable decision support for survival estimation.

Early recognition and rapid appropriate antimicrobial treatment is essential for survival of sepsis. To date, it is unclear which sepsis score should be used for an early diagnosis in calves. The objective of this study was to evaluate two existing scores (Trefz and Fecteau), three novel calf sepsis screening models (CSS, CSS_A, CSS_B), and blood culture as diagnostic test for sepsis, using Bayesian latent class evaluation. A total of 131 sick calves were included in this study. Sepsis prevalence was 45%, 27%, 56%, 47%, and 55%, when using the Trefz score, Fecteau score, CSS, CSS_A, and CSS_B, respectively, and 22% had a relevant positive blood culture. The newly established models CSS (including ≥2 SIRS-criteria and abnormal mental state) and CSS_B (alternative model CSS for practice, substituting abnormal leukocyte count with mucosae) had the highest sensitivity, with 86% and 84%, respectively, and could be interesting screening tests for sepsis. Sensitivity of the existing Trefz and Fecteau score was 70% and 35–39%, respectively. The presented new sepsis scoring systems have potential as screening tests to identify calves at risk, after which a calf-side diagnostic test is advised to confirm the diagnosis. Its use might aid in the rationalization of antimicrobial use in critically ill calves.

Background: Being a life-threatening syndrome, rapid detection of sepsis in critically ill dogs is mandatory. Hypothesis/Objectives: Determine risk factors associated with sepsis in critically ill dogs and evaluate diseases and scoring systems associated with sepsis or mortality. Animals: One hundred thirty critically ill dogs. Methods: Prospective single-center cohort study. Logistic regression and classification and regression tree (CART) analysis were performed to assess clinical and laboratory variables as risk factors for sepsis. Diagnostic and prognostic performance of available scoring systems was evaluated. Results: Sepsis was confirmed in 29 of 130 critically ill dogs (22.3%), and 18 died, with a short-term mortality rate of 62.1%. Pneumonia (odds ratio [OR] = 4.8; 95% confidence interval [CI] = 1.8-13.1; P = .002) and acute kidney injury (AKI; OR = 7.4; 95% CI = 2.2-25.1; P = .001) were associated with sepsis. Multivariable logistic regression identified dyspnea (OR = 6.5; 95% CI = 1.6-26.0; P = .01), respiratory rate (≥38 per minute; OR = 3.9; 95% CI = 1.1-13.1; P = .03), and alanine aminotransferase activity (≥109.5 U/L; OR = 3.8; 95% CI = 1.1-12.8; P = .03) as risk factors for sepsis. When combined, these factors yielded a sensitivity of 35.0% and specificity of 92.8%. The CART analysis identified body weight, tachypnea, hypotension, hyperchloremia, hyperlactatemia, and hyponatremia as risk factors for sepsis (sensitivity, 58.6%; specificity, 97.0%). The APPLE FAST score (OR = 2.9; 95% CI = 1.2-7.1; P = .02) was associated with sepsis. The APPLE FAST score (OR = 3.2; 95% CI = 1.4-7.2; P = .01) was the strongest predictor of mortality. Conclusions and clinical importance: Pneumonia and AKI were associated with sepsis. Identified risk factors may guide veterinarians in the rapid recognition of sepsis. The APPLE FAST score was associated with sepsis and mortality and may support diagnostic and therapeutic decision-making for critically ill dogs with sepsis.

Accurate diagnosis of bloodstream infections is crucial for survival and antimicrobial de-escalation in veterinary medicine. Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry enables faster identification of bacteria in BSIs. This study aimed to compare diagnostic accuracy of two Sepsityper^® methods (Rapid Sepsityper^® and Sepsityper^® Extraction) with conventional culture method for bacterial identification in clinical samples. Mean time-to-positivity and frequency of bacteria in BSIs were also determined. This diagnostic test study used bloodstream infection samples from 385 critically ill animals (121 dogs, 119 foals, and 145 calves) admitted to the Faculty of Veterinary Medicine, Ghent (October 2021-February 2024). Accuracy was compared using Bayesian latent class model with priors for sensitivity (99.9%) and specificity (96.0%) based on literature, and a prevalence of 26.0%. Conventional culture method identified 173 bacteria with Escherichia coli (19.1%,33/173), Staphylococcus spp. (12.1%,21/173) and Streptococcus spp. (8.1%,14/173) being most common. Sensitivity of Rapid Sepsityper^®, Sepsityper^® Extraction, and conventional culture method was 62.1%, 86.1%, and 97.4%, respectively. Specificity was 94.3%, 90.4% and 92.3%, and accuracy was 85.8%, 89.3%, and 93.6%, respectively. Mean time-to-positivity and ±standard deviation for blood cultures flagging positive was 21h25min ±17.8h. Rapid Sepsityper^® identified bacteria in approximately 30min, while Sepsityper^® Extraction method required around 50min, and conventional culture method needed 12-48h. Altogether, Sepsityper^® Extraction shows promise given the sensitivity and results were delivered more rapidly than conventional culture. Enhancing diagnostic workflow, resulting in a better prognosis, reduced hospital stays, and lower healthcare costs due to more rational use of (critically important) antimicrobials.