Background: Septicemia is associated with a systemic inflammatory response, hemostatic activation, and disseminated intravascular coagulopathy (DIC). Hypothesis: Increased plasma D-dimer concentration occurs in septic neonates and can reliably detect sepsis or DIC, and predict death in ill neonatal foals. Animals: 40 septic, 41 nonseptic hospitalized foals, and 22 healthy neonates. Methods: Prospective observational clinical study. Blood samples were collected on admission, at 24-48 hours after admission, and at the time of discharge or euthanasia. Plasma D-dimer concentration, clotting times, antithrombin activity, and fibrinogen concentration were determined. Results: On admission, D-dimer concentration values were significantly higher in septic foals (median, 25-75th percentiles; 568, 245-2013 ng/mL) compared with the nonseptic and healthy groups (386, 175-559 and 313, 152-495 ng/mL, respectively), and in septic foals at the age of 2-7 days compared with similar-age nonseptic foals. By means of samples taken at 24-48 hours of hospitalization and a cut-off value of > 2000 ng/mL, D dimer concentration was significantly associated with the diagnosis of septicemia (odds ratio [OR] = 19.6, 95% confidence interval [95% CI] 1.9-203) and death (OR = 8.7,95% CI 1.8-43). Owing to a high false-positive prediction rate (71%), a normal D-dimer concentration is better at eliminating the diagnosis of sepsis than an increased D-dimer concentration at predicting sepsis. Fifty percent of septic foals had a diagnosis of DIC, but D-dimer concentration was not significantly associated with the diagnosis of DIC. Conclusions and clinical importance: Septic foals showed a marked activation of coagulation and fibrinolytic systems and a high prevalence of DIC. Increased plasma D-dimer concentration is significantly associated with the diagnosis of sepsis. Copyright © 2008 by the American College of Veterinary Internal Medicine.
|Journal||Journal of Veterinary Internal Medicine|
|Publication status||Published - 1 Mar 2008|
- Systemic inflammatory response syndrome