Evaluierung prognostischer Indikatoren der klinischen Untersuchung sowie eines Scoringsystems für Kolikerkrankungen beim Pferd

Zusammenfassung

Gegenstand und Ziel Kolikerkrankungen beim Pferd sind mit einer relativ hohen Mortalitätsrate verbunden. Einige Parameter der klinischen Untersuchung können auf einen negativen Ausgang hindeuten. Die Studie untersuchte, inwiefern eine frühzeitige Vorhersage einer eindeutigen Prognose hinsichtlich des Überlebens des Patienten möglich ist.

Material und Methoden In einer retrospektiven Studie (2013–2017) wurden Ergebnisse der klinischen Untersuchung von Kolikpatienten analysiert und deskriptiv ausgewertet. Untersuchte Parameter wurden entsprechend ihrer Ausprägung in physiologische und pathologische Stufen kategorisiert. Mithilfe von Odds Ratios wurde das Risiko zu versterben im Vergleich zur physiologischen Parameterkategorie untersucht. Die durch Summation einzelner Parameterwerte ermittelten individuellen Gesamtpunktzahlen wurden in Relation zum Ausgang der Erkrankung betrachtet und hinsichtlich eines Schwellenwerts in Bezug auf Prognose und Therapieform untersucht.

Ergebnisse Die Auswertung umfasste 492 Fälle von Kolikerkrankungen. 433 Pferde (88 %) konnten als geheilt entlassen werden. Insgesamt wurden 346 Pferde (70,3 %) konservativ behandelt (96 % überlebend) und 146 Pferde (29,7 %) wurden laparotomiert (69,2 % überlebend). Ein erhöhtes Risiko zu versterben zeigte sich u. a. bei einer Kolikdauer > 6 Stunden (OR = 3,590, p = 0,035), einem Alter von > 20 Jahren (OR = 5,498, p < 0,0005) und einer Zugehörigkeit zur Rassegruppe Kaltblut (OR = 8,364, p < 0,0005). Häufiger verstarben auch Patienten mit einer deutlich erhöhten Herz- bzw. Atemfrequenz (OR = 24,294, p < 0,0005 bzw. OR = 20,375, p < 0,0005) oder einer gesteigerten Blutlaktatkonzentration (> 90 mg/dl; OR = 26,390, p < 0,0005). Mit dem Punktesystem ließ sich nicht eindeutig ein signifikanter Zusammenhang zwischen höherer Gesamtpunktzahl und schlechterer Prognose nachweisen.

Schlussfolgerung und klinische Relevanz Parameter der klinischen Untersuchung sowie anamnestische Angaben können einen Hinweis für die Prognose des vorgestellten Kolikpatienten liefern. Eine eindeutige Klassifizierung hinsichtlich Überleben oder Therapieoption ist jedoch nicht möglich. Eine gründliche Patientenevaluation ist notwendig, um die weitere Therapie auszuwählen und die Prognose bewerten zu können.

Abstract

Subject and aim In horses, colic is associated with relatively high mortality rates. Identification of parameters associated with poor outcome may aid in providing a more accurate prognosis. This study aimed to assess the early prognostic value towards survival of the horse based on parameters of the clinical examination.

Material and methods In a retrospective study (2013–2017), results of the clinical examination of horses with colic were analyzed. Obtained parameters were categorized from physiologic up to different pathophysiologic manifestations. The risk of death was calculated as odds ratios in comparison to normal values of these parameters. Individual score points were obtained and related to the respective outcome. Cut-off values for prognosis and treatment were calculated to distinguish between outcome and treatment group.

Results A total of 492 colic horses were analyzed, presenting 433 survivors (88 %). Overall, medical treatment was selected in 346 (70.3 %) horses (with 96 % survivors) and surgical treatment (laparotomy) was performed in 146 (29.7 %) horses (69.2 % survivors). An increased likelihood of the outcome „death“ was found in horses aged over 20 years (OR = 5.498, p < 0.0005), with colic signs of > 6 hours duration (OR = 3.590, p = 0.035) and, also, for breeds of draft horses (OR = 8.364, p < 0.0005). Horses with significant increases in heart and respiratory rates (OR = 24.294, p < 0.0005 and OR = 20.375, p < 0.0005, respectively) and increased blood lactate concentrations (> 90 mg/dl: OR = 26.390, p < 0.0005) were more likely to succumb to the disease. However, a scoring system failed to show an association between high score points and poor prognosis.

Conclusion and clinical relevance Parameters of the clinical examination as well as the history of the patient may be indicative for the patient’s outcome. However, no clear-cut distinction of the evaluated parameters towards survival and treatment options was obtained. A careful investigation of the patient remains mandatory for selection of treatment and a proper assessment of prognosis.

Schlüsselwörter

Risiko - Überleben - Punktesystem - Parameter - Kolikuntersuchung

Key words

Risk - survival - scoring system - parameters - colic examination

Publication History

Received: 17 April 2021

Accepted: 13 July 2021

Article published online:
19 October 2021

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