Multi-Institutional Retrospective Analysis of Prognostic Scoring Systems for Dogs With Acute Pancreatitis (504 Dogs).

Abstract

BACKGROUND: Acute pancreatitis (AP) in dogs has a broad clinical presentation and variable progression, making prognostication challenging. HYPOTHESIS/OBJECTIVES: (i) To compare predicted prognosis for death and for prolonged (≥ 5 days) hospitalization across scoring schemes for AP in dogs and (ii) to predict concordance of each scoring scheme with death and for prolonged hospitalization. ANIMALS: Five hundred four client-owned dogs. METHODS: Multi-institutional retrospective study. Data extracted from medical records included: signalment, history, physical examination findings, diagnostic results, length of hospitalization, and death. Five prognostic schemes (OS, CSI, APPLE, CAPS, MCAI) were calculated for each dog. RESULTS: Overall concordance was low. Only APPLE(p = 0.004) and MCAI (p = 0.01) scores were significantly different between survivors and non-survivors. Overall, APPLEhad the greatest concordance (0.632, 95% CI: 0.592-0.672) with length of hospitalization. Of the other more pancreatitis-specific schemes, MCAI had the greatest concordance (0.576, 95% CI: 0.567-0.635) with length of hospitalization, while CSI had the lowest concordance with length of hospitalization (0.525, 95% CI: 0.494-0.556). CONCLUSIONS AND CLINICAL IMPORTANCE: On a population level, APPLEand MCAI had the greatest predictive discrimination between dogs of normal and prolonged hospitalization. If an individual dog has any of the 5 prognostic score schemes above the proposed cut-off for death, it should be interpreted with caution because of the low case fatality rate.