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犬肝脓肿:56 例(2010-2019 年)多中心研究。

Hepatic abscessation in dogs: A multicenter study of 56 cases (2010-2019).

机构信息

Department of Clinical Sciences & Advanced Medicine, Matthew J. Ryan Veterinary Hospital, University of Pennsylvania, Philadelphia, Pennsylvania, USA.

Internal Medicine Service, Red Bank Veterinary Hospital, Tinton Falls, New Jersey, USA.

出版信息

J Vet Emerg Crit Care (San Antonio). 2023 Nov-Dec;33(6):665-675. doi: 10.1111/vec.13340. Epub 2023 Nov 9.

Abstract

OBJECTIVE

To investigate the clinical findings, treatment strategies, and outcomes in dogs with confirmed hepatic abscessation.

DESIGN

Retrospective cohort study from 2010 to 2019.

SETTING

Multicenter study.

ANIMALS

Fifty-six client-owned dogs with hepatic abscessation confirmed by culture, cytology, or histopathology.

MEASUREMENTS AND MAIN RESULTS

Dogs were presented for lethargy (39/56), hyporexia (31/56), and vomiting (26/56). Abnormal physical examination findings included increased temperature (41/56) and abdominal pain (22/54). CBCs revealed neutrophilia (31/49), toxic changes (25/49), anemia (28/49), and thrombocytopenia (23/49). Biochemical analyses revealed increased alkaline phosphatase (45/50), increased alanine aminotransferase (40/50), hypoalbuminemia (25/48), and hyperbilirubinemia (19/49). Hypoglycemia was found in 13 of 49 dogs. Hepatic abscesses ranging from 0.5 to 15 cm in diameter were identified ultrasonographically in 37 of 48 dogs; 19 of 37 had solitary abscesses, and 18 of 37 had multifocal abscessation. Escherichia coli was the most commonly cultured organism, isolated in 18 of 42 cases. Histopathology revealed underlying hepatic neoplasia in 10 of 47 dogs. Surgical management was performed in 41 of 49 dogs, and 35 of 41 survived to discharge. Medical management was performed in 8 of 49 dogs, and 5 of 8 survived to discharge. With univariate analysis, hypoglycemia and multifocal abscessation were associated with decreased odds of survival (odds ratio [OR]: 0.2, 95% confidence interval [CI]: 0.03-0.9, P = 0.04; OR: 0.07, 95% CI: 0.01-0.6, P = 0.02, respectively). With multivariate analysis, only multifocal abscessation was associated with decreased odds of survival (OR: 0.09, 95% CI: 0.01-0.87, P = 0.04).

CONCLUSIONS

Hepatic abscessation, although rare, should remain a differential diagnosis for dogs presenting with nonspecific clinical signs and increase liver enzyme activities, especially with concurrent increased temperature and neutrophilia. Rate of survival to discharge for dogs in this study was consistent with previously reported survival rates, with 40 of 56 (71%) of the total population surviving to discharge. No variables assessed were able to predict survival to discharge; however, hypoglycemia and multifocal abscessation should be assessed in larger populations to determine prognostic significance.

摘要

目的

探讨确诊为肝脓肿的犬的临床发现、治疗策略和结局。

设计

2010 年至 2019 年的回顾性队列研究。

地点

多中心研究。

动物

56 只经培养、细胞学或组织病理学证实患有肝脓肿的患犬。

测量和主要结果

犬出现昏睡(39/56)、食欲不振(31/56)和呕吐(26/56)。异常的体格检查发现包括体温升高(41/56)和腹痛(22/54)。CBC 显示中性粒细胞增多(31/49)、中毒变化(25/49)、贫血(28/49)和血小板减少(23/49)。生化分析显示碱性磷酸酶升高(45/50)、丙氨酸氨基转移酶升高(40/50)、低白蛋白血症(25/48)和高胆红素血症(19/49)。49 只犬中有 13 只出现低血糖。在 48 只犬中有 37 只超声检查发现肝脓肿直径为 0.5 至 15 厘米;37 只中有 19 只有单个脓肿,18 只有多个脓肿。大肠杆菌是最常分离的培养物,在 42 例中有 18 例分离到。组织病理学显示 47 只犬中有 10 只有潜在的肝肿瘤。49 只犬中有 41 只进行了手术治疗,其中 35 只存活至出院。49 只犬中有 8 只用药物治疗,其中 5 只存活至出院。单因素分析显示,低血糖和多发性脓肿与存活几率降低相关(比值比[OR]:0.2,95%置信区间[CI]:0.03-0.9,P=0.04;OR:0.07,95%CI:0.01-0.6,P=0.02)。多因素分析显示,只有多发性脓肿与存活几率降低相关(OR:0.09,95%CI:0.01-0.87,P=0.04)。

结论

尽管肝脓肿很少见,但对于出现非特异性临床症状和肝酶活性升高的犬,特别是同时伴有体温升高和中性粒细胞增多的犬,仍应将其作为鉴别诊断。本研究中犬的出院存活率与之前报道的存活率一致,总人群中有 40/56(71%)存活至出院。没有评估任何变量能够预测出院存活率;然而,应在更大的人群中评估低血糖和多发性脓肿,以确定其预后意义。

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