Banca de QUALIFICAÇÃO: ANNA JULIA RODRIGUES PEIXOTO

ELABORATION OF A SCORE FOR DIAGNOSIS, SEVERITY STRATIFICATION AND PROGNOSIS OF SEPSIS IN BITCHES WITH PYOMETRA

organ dysfunction, mortality, SOFA score, dog.

Sepsis is a life-threatening condition, triggered by a dysregulated response of the body to an infection. As it is a syndrome with non-specific signs, symptoms and progression, early diagnosis is challenging and crucial to reducing its high morbidity and mortality rates. The present study aims to develop a score for diagnosis, severity stratification and prognosis, similar to the SOFA score, for dogs with sepsis due to pyometra. This is a retrospective cohort study conducted by analyzing 136 medical records of bitches diagnosed with pyometra and treated at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro, from May 2017 to May 2020. Records with comorbidities with systemic repercussions were excluded. All the data analyzed was taken from the admission exams, collected before any pharmacological interventions. Mortality was evaluated up to the 14th day after admission. Sepsis was considered present when any one (or more) of the following organic dysfunction criteria were identified: systolic blood pressure < 100 mmHg; 13 points or less on the modified Glasgow Coma Scale for dogs; platelet count < 200,000/μL; total serum bilirubin > 0.5 mg/dl and; serum creatinine > 1.7 mg/dl. To develop the score, risk analysis and logistic regression were performed to identify the variables with the greatest impact on the outcome of sepsis and mortality. The prediction models were developed in accordance with the recommendations of the Transparent Reporting of a multivariable prediction model for Individual Prognosis or Diagnosis (TRIPOD). The scaling of the variables selected to stratify severity was based on the normality values available in the literature, plus the standard deviations obtained from the 136 samples. Four scoring models were proposed with varying combinations of predictors: score A punctuates cardiovascular, hemostatic, neurological, hepatic, renal dysfunctions and changes in appetite at 4 levels of severity; score B differs from A in the method of assessing mental state; score C stratifies the same predictors as A, into just 3 levels of severity and adds assessment of blood lactate and presence of diarrhea; score D uses the same predictors as A, stratifying them into 3 levels of severity. The APPLE score (The Acute Patient Physiologic and Laboratory Evaluation) and the SIRS (Systemic Inflammatory Response Syndrome) criteria already validated in veterinary medicine were also performed on the same samples for comparison purposes. The variables were subjected to the D’Agostino K2 normality test and for comparisons between groups, one-way ANOVA or Kruskal Wallis was used. Model discrimination analyzes were performed using ROC (Receiver Operator Curve) analyzes using the area under the curve (AUROC) and AUROC > 0.7 was considered acceptable. The average age of the general population was 8±4 years and body weight was 14±10 kg. The criteria adopted to define sepsis were present in 79% (107) of these animals. Thirteen animals (9.5%) died. All applied scores obtained statistically discrepant scores between surviving and non-surviving animals. Animals that died reached significantly higher medians compared to survivors (p<0.001). Only in the SRIS classification was this level of statistical significance lower (p= 0.043). The lowest median points among non-survivors was obtained in score D (4 points) and the highest in scores B and C (8 points). In the ROC analyses, the APLLE score presented the best performance for discriminating mortality, followed by the proposed score C, but scores A and B also presented acceptable AUROC values for the same outcome. A specific and easy-to-apply score for evaluating septic dogs aims to make diagnosis faster and assist in making therapeutic decisions, aiming to reduce high mortality rates.