Chronic enteropathies in dogs evaluation of risk factors for negative outcome allenspach et al 2007

Page 1

J Vet Intern Med 2007;21:700–708

Chronic Enteropathies in Dogs: Evaluation of Risk Factors for Negative Outcome K. Allenspach, B. Wieland, A. Gro¨ne, and F. Gaschen Hypothesis: Certain variables that are routinely measured during the diagnostic evaluation of dogs with chronic enteropathies will be predictive for outcome and a new clinical disease activity index incorporating these variables can be applied to predict outcome of disease. Animals: Seventy dogs were entered into a sequential treatment trial with elimination diet (FR, food-responsive group) followed by immunosuppressive treatment with steroids if no response was seen with the dietary trial alone (ST, steroidtreatment group). A 3rd group consisted of dogs with panhypoproteinemia and ascites (PLE, protein-losing enteropathy) that were treated with immunosuppressive doses of steroids. Methods: Three years of follow-up information was available for all dogs. Clinicopathologic variables were tested for their ability to predict negative outcome, defined as euthanasia due to refractoriness to treatment. Different scoring systems including different combinations of these variables were evaluated using receiver operating characteristic (ROC) curves. Results: Thirteen of 70 (18%) dogs were euthanized because of intractable disease. Univariate analysis identified a high clinical activity index, high endoscopic score in the duodenum, hypocobalaminemia (,200 ng/L) and hypoalbuminemia (,20 g/L) as risk factors for negative outcome. Conclusions and clinical importance: Based on the factors identified by logistic regression and ROC curve analysis, a new clinical scoring index (CCECAI) was defined that predicts negative outcome in dogs suffering from chronic enteropathies. Key words: Canine; Chronic Diarrhea; Clinicopathologic variables; Prognosis.

mong the causes for chronic enteropathies (CE) in dogs, adverse reaction to food, idiopathic inflammatory bowel disease (IBD), and antibiotic-responsive diarrhea (ARD) are common.1–4 These disorders are diagnosed retrospectively by their response to treatment. Little information is available on clinical and clinicopathologic markers that may help distinguish between cases that respond to diet alone and those that require treatment with corticosteroids. Furthermore, little information is available on risk factors associated with refractoriness to treatment leading to euthanasia of affected animals.5 The purpose of this prospective study therefore was to evaluate standard tests performed during diagnostic evaluation of CE cases for their accuracy to predict response to therapy and outcome. Specifically, clinical signs, CBC, serum biochemical analysis, serum co-

A

From the Small Animal Teaching Hospital of the University of Bern, Department of Veterinary Clinical Medicine, Vetsuisse Faculty, Switzerland (Allenspach, Gro¨ne, Gaschen); and the Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, North Mymms, UK (Wieland). Dr Karin Allenspach is currently affiliated with the Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, North Mymms, UK. Dr Andrea Gro¨ne is currently affiliated with the Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands. Dr Frederic Gaschen is currently affiliated with the Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA. This study was presented in part at the ACVIM Forum 2006 in Louisville, KY. May 31-June 3. Reprint requests: Karin Allenspach DVM., Department of Veterinary Clinical Sciences, Royal Veterinary College, University of London, Hawkshead Lane, North Mymms, Hatfield, AL9 7TA; e-mail: kallenspach@rvc.ac.uk. Submitted August 16, 2006; Revised October 18, 2006 and November 17, 2006; Accepted January 22, 2006 Copyright E 2007 by the American College of Veterinary Internal Medicine 0891-6640/07/2104-0004/$3.00/0

balamin and folate concentrations, 2-dimensional transabdominal ultrasound, endoscopy, and histopathology were evaluated for their usefulness to predict outcome. This study was part of a larger study with the broad goal of investigating the pathogenesis and treatment of CE in dogs performed at the University of Bern between 2002 and 2005. We aimed additionally to assess previously proposed markers of disease (ie, albumin5 and Creactive protein [CRP]6) for their effectiveness to predict response to treatment and outcome. We carried out a prospective study design and obtained objective data on clinical variables by using a previously published clinical scoring system (CIBDAI, canine IBD activity index),6 endoscopic scoring, and histologic scoring before and after a standardized treatment regimen.

Materials and Methods Over the 3-year period, 78 dogs with signs of chronic gastrointestinal disease were referred to the Small Animal Teaching Hospital, Vetsuisse Faculty, University of Bern, Switzerland. Four dogs were excluded because of intestinal neoplasia (2 lymphoma, 1 colonic adenocarcinoma, and 1 intestinal histiocytic sarcoma). Four dogs tested positive for Campylobacter spp. on fecal culture and had clinical signs consistent with acute campylobacter infection. In all other dogs, fecal culture results were negative for Campylobacter spp., Salmonella spp., Yersinia spp., and enteropathogenic Escherichia coli. The 4 dogs with positive cultures for Campylobacter spp. were successfully treated with erythromycin (15 mg/kg PO q8h for 4 weeks) and were excluded from the study. Seventy dogs were included in the prospective treatment trial. Some information about the clinical signs in 35 of the dogs in this study has been published elsewhere.7 Follow-up information was available for all 70 dogs during a period of 3 years after finishing the treatment trial. Owners of dogs were contacted every month by telephone and the dogs were re-examined if their clinical signs were worsening at any time point. Selection criteria for cases included a history of chronic diarrhea with or without vomiting of at least 6 weeks duration, exclusion of identifiable underlying disorders, and histopathologic evidence of intestinal inflammatory cellular infiltrates. None of the dogs had been treated with antibiotics, corticosteroids, or antacids in the 2 weeks before entering the


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.