Chu Victoria, Goggs Robert, Bichoupan Allison, Radhakrishnan Shalini, Menard Julie
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States.
Front Vet Sci. 2021 Mar 8;8:636732. doi: 10.3389/fvets.2021.636732. eCollection 2021.
In humans with sepsis, hypophosphatemia is a marker of illness severity and a negative prognostic indicator. Hypophosphatemia has not been previously investigated in dogs with sepsis, however. This study aimed to estimate the prevalence of hypophosphatemia in dogs, the prevalence of presumptive sepsis in dogs with hypophosphatemia, the prevalence of hypophosphatemia in dogs with presumptive sepsis and the association between outcome and hypophosphatemia in dogs with presumptive sepsis. Electronic medical records of the Cornell University Hospital for Animals from 2008-2018 were queried to identify all dogs with hypophosphatemia and all dogs with presumptive sepsis. Hypophosphatemia was defined as a serum phosphate concentration <2.7 mg/dL. Sepsis was presumed where ≥2 of 4 systemic inflammatory response syndrome (SIRS) criteria were satisfied associated with a documented or highly suspected infection. Variables were assessed for normality using the D'Agostino-Pearson test. Continuous variables were compared between groups using the Mann-Whitney test. Differences in frequency between categorical variables were analyzed using contingency tables, calculation of Fisher's exact test or Chi and estimation of odds ratios. In the study period, 47,992 phosphate concentration measurements from 23,752 unique dogs were identified. After eliminating repeat analyses, the period prevalence of hypophosphatemia on a per dog basis over the 11-year study period was 10.6% (2,515/23,752). The prevalence of presumptive sepsis within dogs with hypophosphatemia was 10.7% (268/2,515). During the 11-year study period, 4,406 dogs with an infection were identified, of which 1,233 were diagnosed with presumptive sepsis and had a contemporaneous phosphate concentration. Hypophosphatemia was more prevalent in dogs with presumptive sepsis than in dogs without 21.7 vs. 10.2%; OR 2.44 [95% CI 2.12-2.81]; < 0.0001. The mortality rate was greater in dogs with hypophosphatemia and presumptive sepsis than in dogs with hypophosphatemia without presumptive sepsis (15.3 vs. 3.1%; OR 5.70 [95% CI 3.76-8.52]; < 0.0001), however hypophosphatemia was not associated with outcome in dogs with presumptive sepsis OR 0.87 [95% CI 0.60-1.26]; = 0.518. In dogs with hypophosphatemia, a presumed diagnosis of sepsis was associated with increased mortality compared to other associated disease processes. In dogs with presumptive sepsis, hypophosphatemia was not associated with outcome.
在患有脓毒症的人类中，低磷血症是疾病严重程度的一个指标和不良预后指标。然而，此前尚未对患有脓毒症的犬进行过低磷血症的研究。本研究旨在评估犬低磷血症的患病率、低磷血症犬中疑似脓毒症的患病率、疑似脓毒症犬中低磷血症的患病率，以及疑似脓毒症犬的低磷血症与预后之间的关联。查询了康奈尔大学动物医院2008年至2018年的电子病历，以识别所有患有低磷血症的犬和所有疑似脓毒症的犬。低磷血症定义为血清磷酸盐浓度<2.7mg/dL。当满足4项全身炎症反应综合征（SIRS）标准中的≥2项且伴有记录在案或高度怀疑的感染时，则推定患有脓毒症。使用D'Agostino-Pearson检验评估变量的正态性。使用Mann-Whitney检验比较组间的连续变量。使用列联表、Fisher精确检验或卡方检验计算分类变量之间的频率差异，并估计比值比。在研究期间，共识别出来自23,752只不同犬的47,992次磷酸盐浓度测量值。在排除重复分析后，11年研究期间每只犬低磷血症的期间患病率为10.6%（2,515/23,752）。低磷血症犬中疑似脓毒症的患病率为10.7%（268/2,515）。在11年研究期间，识别出4,406只感染犬，其中1,233只被诊断为疑似脓毒症并同时检测了磷酸盐浓度。疑似脓毒症犬的低磷血症患病率高于无脓毒症犬（21.7%对10.2%；比值比2.44[95%置信区间2.12 - 2.81]；P<0.0001）。低磷血症且疑似脓毒症犬的死亡率高于低磷血症但无疑似脓毒症犬（分别为15.3%对3.1%；比值比5.70[95%置信区间3.76 - 8.52]；P<0.0001），然而，低磷血症与疑似脓毒症犬的预后无关（比值比0.87[95%置信区间0.60 - 1.26]；P = 0.518）。在低磷血症犬中，与其他相关疾病过程相比，推定的脓毒症诊断与死亡率增加相关。在疑似脓毒症犬中，低磷血症与预后无关。
