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Karol Mathews DVM DVSc DACVECC (Canada) Peter W Kronen Dr Vet Med, DVM DECVAA (Switzerland) Duncan Lascelles BSc BVSc PhD DSAS DECVS DACVS MRCVS (USA) Andrea Nolan MVB DVA PhD DECVAA DECVPT MRCVS (UK) Sheilah Robertson BVMS (Hons) PhD DACVAA DECVAA DECAWBM (WSEL) DACAW MRCVS (USA) Paulo VM Steagall MV MS PhD DACVAA (Brazil/Canada) Bonnie Wright DVM DACVAA (USA) Kazuto Yamashita DVM MS PhD DJCVS (Japan)

To determine the incidence of in-hospital adverse outcomes including acute kidney injury (AKI) and death in a population of dogs admitted to the intensive care unit (ICU) receiving 10% hydroxyethyl starch (HES) [250/0.5/5:1] compared with the general ICU population, while controlling for illness severity.Cohort study conducted between January 2007 and March 2010.Veterinary teaching hospital.Consecutive sample of dogs receiving HES (n = 180) were compared with a randomly selected sample of dogs (n = 242) admitted to the ICU over the same period.NoneAKI was defined as an at least 2-fold increase in baseline creatinine concentration or new onset of oliguria/anuria persisting for ≥12 hours. The primary outcome was a composite of in-hospital death or AKI. Unadjusted and adjusted analysis controlling for illness severity using the acute patient physiologic and laboratory evaluation (APPLEfast ) score and other confounders was performed. HES was administered either as incremental boluses (median dose 8.2 mL/kg/day, interquartile range [IQR] 5.0-11.3 mL/kg/day) or as a continuous rate infusion (CRI; median dose 26mL/kg/day, IQR 24.0-48 mL/kg/day). In unadjusted analysis, HES administration was associated with increased risk of mortality (odds ratio [OR] = 2.33, 95% confidence interval [CI] = 1.51-3.58, P0.001) or AKI (OR = 3.87, 95% CI = 1.21-12.37, P = 0.02). In an adjusted analysis after controlling for illness severity, admission type, and concurrent administration of blood products, HES administration remained an independent risk factor for the composite adverse outcome (OR = 1.98, 95% CI = 1.22-3.22, P = 0.005), with a number needed to harm (NNH) = 6 (95% CI = 4-23).HES therapy is associated with increased risk of an adverse outcome including death or AKI in dogs. A randomized controlled trial investigating the safety of HES therapy in canine patients is warranted.

This article provides an overview of the complex relationship between inflammation and coagulation and a review of routinely available laboratory and point-of-care tests for the detection of inflammation and coagulopathies. In the management of cases requiring ongoing laboratory and clinical evaluation, examination of these two major pathologic processes may assist with diagnosis and improve outcome. Early identification of a pathologic inflammatory process may allow prevention of its progression to syndromes carrying a poorer prognosis, such as disseminated intravascular coagulation and multiple organ dysfunction syndrome.

To assess the relationship between total plasma protein (TPP) as measured by refractometry and serum hypoalbuminemia and hypoproteinemia in hospitalized dogs.Retrospective, observational study conducted over 6-month period between March and August 2008.University teaching hospital.Four hundred and three hospitalized dogs in an ICU.None.TPP, serum albumin, total protein, glucose, urea, cholesterol was measured from dogs enrolled in study. TPP was evaluated as a predictor for hypoalbuminemia defined both as albumin25 g/L (2.5 g/dL) and albumin20 g/L (2.0 g/dL), and serum hypoproteinemia, defined as serum total protein40 g/L (4.0 g/dL), using logistic regression. Impact of glucose, urea, cholesterol, and total bilirubin on refractometric readings were also assessed. TPP predicted hypoalbuminemia at albumin concentrations of25 g/L (2.5 g/dL) and20 g/L (2.0 g/dL) (P0.001). A TPP60 g/L (6.0 g/dL) predicted albumin25 g/L (2.5 g/dL) with 73% sensitivity and 86% specificity. A TPP58 g/L (5.8 g/dL) predicted a serum albumin20 g/L (2.0 g/dL) with 70% sensitivity and 80% specificity. For dogs with known risk factors where specificity optimization may be appropriate, refractometer TPP50 g/L (5.0 g/dL) and48 g/L (4.8 g/dL) predicted hypoalbuminemia at each level with95% specificity, although sensitivity was poor. Refractometer TPP58 g/L (5.8 g/dL) predicted serum total protein of40 g/L (40 g/dL) with sensitivity of 82% and specificity of 84%. Hypercholesterolemia and hyperglycemia significantly affected TPP readings; an increase in serum glucose by 10 mmol/L (180 mg/dL) was associated with an average independent increase in refractometer TPP of 2.27 g/L (0.23 g/dL) (P0.001, 95% confidence interval=1.08-3.47) and an increase in serum cholesterol of 1 mmol/L (38.6 mg/dL) was associated with an average independent increase in refractometer TPP of 1.36 g/L (0.14 g/dL) (P0.001, 95% confidence interval=1.12-1.59).Suboptimal sensitivity limits the use of refractometric TPP for prediction of hypoalbuminemia in the context of patient screening; a high proportion of false negatives may result. However, identification of a refractometric TPP58 g/L is strongly indicative of both serum hypoalbuminemia and hypoproteinemia, with high specificity, and warrants further investigation. Refractometric readings may be falsely increased in patients with hyperglycemia or hypercholesterolemia.