Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea

Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. The mortality rate was 22%. Classification tree analysis indicated that mortality was associated with clinical signs of neurologic disease, abdominal emergencies, cachexia, orthopedic problems such as septic arthritis, and profound acidemia (jugular venous blood pH < 6.85). When exclusively considering laboratory parameters, classification tree analysis identified plasma glucose concentrations < 3.2 mmol/L, plasma sodium concentrations ≥ 151 mmol/L, serum GGT activity < 31 U/L and a thrombocyte count < 535 G/L as predictors of mortality. However, multivariable logistic regression models based on these laboratory parameters did not have a sufficiently high enough sensitivity (59%) and specificity (79%) to reliably predict treatment outcome. The sensitivity and specificity of jugular venous blood pH < 6.85 were 11% and 97%, respectively, for predicting non-survival in this study population. We conclude that laboratory values (except jugular venous blood pH < 6.85) are of limited value for predicting outcome in critically ill neonatal calves with diarrhea. In contrast, the presence of specific clinical abnormalities provides valuable prognostic information.

重度酸中毒严重损害细胞及器官功能，从而在危重病患及动物中应与死亡率增加的风险相联系。犊牛新生腹泻可能导致潜在的严重代谢紊乱，包括由于强离子（代谢）酸中毒引起的重度酸中毒、高D-乳酸血症、高L-乳酸血症、氮质血症、低血糖、高钾血症及低钠血症。本项回顾性研究的目的是评估临床及实验室发现对1,400名因腹泻被送往兽医教学医院的危重新生犊牛的临床预后相关性。死亡率达到22%。分类树分析表明，死亡率与神经性疾病症状、腹部紧急情况、恶病质、如化脓性关节炎等骨科问题以及重度酸中毒（颈静脉血pH < 6.85）的临床征象相关。当仅考虑实验室参数时，分类树分析确定了血浆葡萄糖浓度< 3.2 mmol/L、血浆钠浓度≥ 151 mmol/L、血清γ-谷氨酰转移酶活性< 31 U/L及血小板计数< 535 G/L为死亡率的预测指标。然而，基于这些实验室参数的多变量逻辑回归模型并未具有足够高的灵敏度（59%）和特异性（79%），不足以可靠地预测治疗效果。在本研究人群中，颈静脉血pH < 6.85对预测非存活率的灵敏度和特异性分别为11%和97%。据此，我们得出结论，实验室指标（除颈静脉血pH < 6.85外）对于预测危重新生犊牛腹泻的预后价值有限。相反，特定临床异常的存在提供了宝贵的预后信息。