In human critical care, patients with the highest cortisol concentrations generally have the highest mortality rates, with resultant prognostic classifications based on basal cortisol and/or delta cortisol concentrations. In contrast, comparative data on canine critical illness does not exist. Parvoviral diarrhoea is a severe infectious disease inducing a sepsis-like state predominantly in paediatric canine patients. The objective of this study was to evaluate the prognostic value of basal serum cortisol concentrations in canine parvoviral diarrhoea. A prospective, in vivo study was conducted on clinical cases of parvoviral diarrhoea meeting the criteria for admission to a high care ward in a veterinary academic hospital. Forty-five patients were enrolled and had their basal serum cortisol concentrations measured at admission and daily until death or discharge. Mortality was assessed as a function of basal cortisol concentrations obtained at day 2 in the whole cohort. Specificity and sensitivity data were obtain using empirical ROC curves.
Day 2 cortisol concentrations of >224 nmol/l had a specificity of 100%, a sensitivity of 75% and a 1.00 positive predictive value for mortality in paediatric canine patients with parvoviral diarrhoea. Basal cortisol concentrations in canine patients are considerably lower than in human patients, reflecting the lower reference range (10160 nmol/l) of this species. The results are in accordance with human critical care data, allowing for prognostication based on basal cortisol concentrations. This data contributes to the affirmation of the dog as a model for conducting studies in the human critical care field. Our data suggest that basal cortisol concentrations have a good prognostic value and could be helpful in identifying patients with parvoviral diarrhoea at high risk of death. Further studies will have to be conducted to determine whether the same is true for the short Synacthen test, as is the case in humans.
01 - 05 Apr 2006
European Society of Endocrinology