Hemostatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus

Summary

Objective: Prospective characterization of hemostastatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus (GDV). Material and methods: Coagulation variables (platelets, prothrombin time [PT], activated partial thromboplastin time [aPTT], fibrinogen, antithrombin [AT], protein C [PC], protein S [PS], D-dimers), plasma lactate concentration and inflammatory biomarkers (C-reactive protein, white blood cell [WBC] count, lymphocyte and neutrophil numbers) were assessed in 20 dogs with GDV presented between 2011 and 2012. Blood was taken preoperatively and at days 1 and 3 postoperatively. The prognostic value of these variables before and after surgery was evaluated as well as the behavior of variables during the study. Results: Overall, 7/20 (35%) dogs did not survive; two dogs (29%) were euthanized during surgery due to severe gastric necrosis and 5 (71%) dogs after surgery due to sepsis and disseminated intravascular coagulopathy. Prior to surgery, median plasma lactate concentration was significantly (p = 0.01) lower in survivors (6.2 mmol/l, range 1.9–9.7 mmol/l) when compared to non-survivors (11.8 mmol/l, range 7.5–16.2 mmol/l). In dogs dying after surgery, significantly higher plasma lactate concentration, coagulation times and D-dimer concentration were present as well as lower fibrinogen concentration and activity of PC and AT compared to survivors. At discharge, activity of AT, PC and PS were markedly below the reference interval in 6/13 (46%), 11/13 (85%), and 8/13 (62%) dogs, respectively. Clinical relevance: Only lactate plasma concentration was of preoperative prognostic value. After surgery, severe abnormalities of coagulation variables, especially the endogenous anticoagulants were present in most of the dogs. The severity of the abnormalities was associated with survival.

Zusammenfassung

Ziel: Prospektive Analyse eines erweiterten Gerinnungsspektrums, der Laktatplasmakonzentration und von Entzündungsparametern bei Hunden mit Torsio ventriculi. Material und Methoden: In den Jahren 2011 und 2012 wurden bei 20 Hunden mit Torsio ventriculi Gerinnungsparameter (Thrombozytenzahl, Thromboplastinzeit [PT], aktivierte partielle Thromboplastinzeit [aPTT], Fibrinogen, Antithrombin [AT], Protein C [PC], Protein S [PS], D-Dimere), die Laktatplasmakonzentration und die Entzündungsparameter (C-reaktives Protein [CRP], Leukozyten, Lymphozyten und neutrophile Granulozyten) untersucht. Die Blutprobenentnahme erfolgte präoperativ, an Tag 1 und Tag 3 post operationem. Die prognostische Relevanz der Blutparameter präund postoperativ sowie ihr Verlauf während der Erkrankung wurden evaluiert. Ergebnisse: Sieben der 20 Hunde (35%) verstarben. Zwei Tiere (29%) mit hochgradiger Magenwandnekrose wurden intraoperativ euthanasiert und 5 Hunde (71%) nach der Operation aufgrund von Sepsis und disseminierter intravasaler Gerinnung. Präoperativ lag die mediane Laktatplasmakonzentration überlebender Hunde (6,2 mmol/l, Spanne 1,9–9,7 mmol/l) signifikant (p = 0,01) niedriger als die der euthanasierten Tiere (11,8 mmol/l, Spanne 7,5–16,2 mmol/l). Direkt nach der Operation wiesen Hunde, die später euthanasiert wurden, im Vergleich zu den überlebenden Patienten signifikant höhere Laktatplasmakonzentrationen, Gerinnungszeiten, D-Dimer-Konzentrationen sowie signifikant niedrigere Fibrinogenkonzentrationen, PC- und AT-Aktivitäten auf. Am Entlassungstag lagen die Aktivitäten von AT, PC und PS bei 6/13 (46%), 11/13 (85%) bzw. 8/13 (62%) der Hunde deutlich unterhalb des Referenzbereichs. Klinische Relevanz: Die Laktatplasmakonzentration besaß als einziger Parameter eine präoperative prognostische Aussagekraft. Postoperativ zeigten die meisten Hunde veränderte Werte der Gerinnungsparameter, insbesondere der endogenen Antikoagulanzien, wobei der Schweregrad der Veränderungen mit dem Überleben assoziiert war.

Keywords

Dog - hemostasis - protein C - protein S - antithrombin

Schlüsselwörter

Hund - Gerinnung - Protein C - Protein S - Antithrombin

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