Murgia Elsa, Troia Roberta, Bulgarelli Cecilia, Pelizzola Marco, Foglia Armando, Dondi Francesco, Giunti Massimo
Department of Veterinary Medical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
Front Vet Sci. 2019 Jun 21;6:189. doi: 10.3389/fvets.2019.00189. eCollection 2019.
Polytrauma is a common emergency condition in small animals and is frequently associated with higher morbidity and mortality rates compared to minor trauma. Multiple Organ Dysfunction Syndrome (MODS) is a major complication of extensive traumatic injury, carrying a high risk of death despite intensive care treatment. Little is known about the prevalence and the prognostic impact of MODS in feline polytrauma. The current study aimed to prospectively evaluate the occurrence and the prognostic significance of organ dysfunction at admission in a population of polytraumatized cats. Cats with polytrauma requiring intensive care unit hospitalization were included and categorized according to outcome (survivors/non-survivors). Clinical and clinicopathological data, including scores of disease severity [Animal Trauma Triage Score (ATTS), APPLE, and APPLE], selected organ dysfunction and presence of MODS were evaluated upon admission, and analyzed with respect to mortality. Non-parametric statistics was performed and < 0.05 was considered significant. Thirty-eight cats met the inclusion criteria: 8/38 (21%) had penetrating trauma, while 30/38 (79%) had blunt trauma. The overall in-hospital mortality was 37% (14/38). Cats with evidence of MODS upon admission had significantly higher frequency of death compared to cats without MODS (9/14 vs. 2/24 = 0.0004). Hemostatic dysfunction, respiratory dysfunction, and MODS upon admission were significantly associated with mortality in the univariate logistic regression analysis ( = 0.005, = 0.001, = 0.001, respectively). The values of APPLE, APPLE, and ATTS were independently associated with a higher risk of death and positively correlated with the number of dysfunctional organs ( = 0.025, = 0.004, = 0.003, = 0.57, = 0.0002; = 0.59, = 0.0001; = 0.55, = 0.0003, respectively). Multiple Organ Dysfunction Syndrome is a common complication of feline polytrauma and its development is associated with increased disease severity and worse outcomes. The presence of hemostatic dysfunction and respiratory dysfunction upon admission is associated with a higher risk of death. The ATTS and the APPLE scores are useful prognostic tools for the assessment of cats with polytrauma.
多发伤是小动物常见的急症，与轻度创伤相比，其发病率和死亡率通常更高。多器官功能障碍综合征（MODS）是广泛创伤性损伤的主要并发症，尽管进行了重症监护治疗，仍有很高的死亡风险。关于猫多发伤中MODS的患病率及其预后影响知之甚少。本研究旨在前瞻性评估多发伤猫群体入院时器官功能障碍的发生情况及其预后意义。纳入需要入住重症监护病房的多发伤猫，并根据结局（存活/非存活）进行分类。入院时评估临床和临床病理数据，包括疾病严重程度评分[动物创伤分诊评分（ATTS）、APPLE和APPLE]、选定的器官功能障碍和MODS的存在情况，并分析其与死亡率的关系。采用非参数统计，P<0.05被认为具有统计学意义。38只猫符合纳入标准：8/38（21%）为穿透性创伤，而30/38（79%）为钝性创伤。总体住院死亡率为37%（14/38）。入院时有MODS证据的猫与无MODS的猫相比，死亡频率显著更高（9/14 vs. 2/24，P = 0.0004）。单因素逻辑回归分析显示，入院时的止血功能障碍、呼吸功能障碍和MODS与死亡率显著相关（分别为P = 0.005、P = 0.001、P = 0.001）。APPLE、APPLE和ATTS评分与较高的死亡风险独立相关，且与功能障碍器官的数量呈正相关（分别为P = 0.025、P = 0.004、P = 0.003，r = 0.57、P = 0.0002；r = 0.59、P = 0.0001；r = 0.55、P = 0.0003）。多器官功能障碍综合征是猫多发伤的常见并发症，其发生与疾病严重程度增加和预后较差有关。入院时存在止血功能障碍和呼吸功能障碍与较高的死亡风险相关。ATTS和APPLE评分是评估多发伤猫的有用预后工具。
