Swales Harry, Batchelor Daniel J, O'Connell Erin M
J Am Vet Med Assoc. 2020 May 1;256(9):1034-1040. doi: 10.2460/javma.256.9.1034.
To investigate whether serum cortisol (SC) concentration is a useful prognostic indicator for survival versus nonsurvival to hospital discharge in critically ill dogs.
229 client-owned dogs.
Medical records were retrospectively reviewed to identify critically ill dogs that were hospitalized between January 2010 and May 2018 and that had SC concentrations measured ≤ 3 days after admission. Results for SC concentrations were compared for dogs grouped by survival versus nonsurvival to hospital discharge, with versus without sepsis, and other variables of interest. The predictive value of SC concentration for nonsurvival to hospital discharge was assessed (OR, sensitivity, and specificity) for cutoffs determined from a ROC curve or reference limit.
Median SC concentration was higher in dogs that did not survive to hospital discharge (8.5 μg/dL; interquartile [25th to 75th percentile] range, 4.8 to 11.8 μg/dL), compared with concentration in those that were discharged alive (4.5 μg/dL; interquartile range, 2.5 to 6.9 μg/dL). The area under the ROC curve was 0.72 (95% confidence interval [CI], 0.64 to 0.81) for SC concentration predicting nonsurvival. The calculated optimum cutoff of SC concentration was 7.6 μg/dL, at which the OR, sensitivity, and specificity for nonsurvival were 5.4 (95% CI, 2.7 to 10.9), 58%, and 80%, respectively. Alternatively, when the upper reference limit for SC concentration (5.8 μg/dL) was used as the cutoff, the OR, sensitivity, and specificity for nonsurvival were 3.6 (95% CI, 1.8 to 7.1), 67%, and 64%, respectively.
Results indicated that SC concentration could be used as part of an overall assessment of prognosis in critically ill dogs.
探讨血清皮质醇（SC）浓度是否为危重病犬存活至出院或未存活至出院的有用预后指标。
229只客户拥有的犬。
对病历进行回顾性审查，以确定2010年1月至2018年5月期间住院且入院后≤3天测量SC浓度的危重病犬。比较存活至出院与未存活至出院、有脓毒症与无脓毒症以及其他感兴趣变量分组的犬的SC浓度结果。评估SC浓度对未存活至出院的预测价值（比值比、敏感性和特异性），以确定来自ROC曲线或参考限值的临界值。
未存活至出院的犬的SC浓度中位数较高（8.5μg/dL；四分位数间距[第25至75百分位数]范围，4.8至11.8μg/dL），而存活出院的犬的浓度为（4.5μg/dL；四分位数间距，2.5至6.9μg/dL）。预测未存活的SC浓度的ROC曲线下面积为0.72（95%置信区间[CI]，0.64至0.81）。计算得出的SC浓度最佳临界值为7.6μg/dL，此时未存活的比值比、敏感性和特异性分别为5.4（95%CI，2.7至10.9）、58%和80%。或者，当SC浓度的参考上限（5.8μg/dL）用作临界值时，未存活的比值比、敏感性和特异性分别为3.6（95%CI，1.8至7.1）、67%和64%。
结果表明，SC浓度可作为危重病犬总体预后评估的一部分。
