Aspectos diagnósticos y pronósticos de la concentración de albúmina en el paciente canino con síndrome de respuesta inflamatoria sistémica

Abstract

Acid-base disturbances have been reported in the veterinary literature concerning the field of the small animal intensive care. Such disorders have diagnostic, therapeutic, and prognostic implications in terms of morbidity and mortality in such population. Besides albumin is a weak acid that can affect pH and plays a key role in the metabolic component of the acid-base balance often is not taken into account during the acid-base assessment. The main goal of the first study was to compare the traditional and the quantitative approaches for the assessment of acid-base imbalances in hypoalbuminemic dogs. This study was designed as a prospective observational clinical study and included the evaluation of 105 critically ill patients and 135 healthy patients as controls. Jugular venous-blood samples were collected from each patient on admission to determine: TP, Alb , BUN, Glu , hematocrit, , Na+ , Cl- , K +, Pi , pH , pCO2 , HCO3 - , AG, AGalb and /or AGalb-phos, SBE, SID, Atot , and SIG. Patients were divided into two groups according to the severity of hypoalbuminemia: mild hypoalbuminemia (Alb = 2.1 to 2.5 g /dL) and severe hypoalbuminemia (Alb ≤ 2.0 g/dL). According to the HH approach most frequent imbalances were simple disorders (51.4 %) mainly metabolic acidosis (84.7%), in most cases associated to a high AG acidosis. However, when using the quantitative method 58.1% were complex disorders, and SIG acidosis (74.3 %) and Atot alkalosis (33.3 %) were the most frequent acid -base imbalances. The second study allowed us to conclude that the agreement between the traditional and quantitative methods of interpretation of acid-base balance was poor, and many imbalances were detected using the quantitative approach but would remain undetected using the traditional approach to acid-base status. Moreover, these alterations were different according to the severity of hypoalbuminemia and characteristics of the disease in each hypoalbuminemic patient, especially in SIRS/septic patients. In humans, SIRS is relatively frequent condition and is associated with high mortality rates. However, data on the incidence of SIRS and the usefulness of biomarkers in veterinary medicine is scarce. The main goal of the second study was to determine the diagnostic and prognostic value of plasma iron vs the inflammatory markers albumin, CRP and fibrinogen on admission and over the ICU stay of dogs with SIRS. This study was designed as prospective observational study and included 116 client-owned dogs: 54 dogs with SIRS/sepsis, 42 with local inflammation and 20 clinically healthy dogs as a control group. Blood samples were taken on admission in all study groups, and then on alternate days until discharge or death in both inflammation groups. On admission, dogs with SIRS had significantly lower plasma iron (65 ± 5.8 µg/dL, p=0.001) concentrations than dogs with local inflammation (89.5 ± 6.2 µg/dL, p=0.001). Plasma iron, albumin, and CRP were able to separate dogs in the SIRS/sepsis group from those presenting local inflammation with AUCs for the ROCs curves of 0.679, 0.834, and 0.704 respectively. The admission values for these variables did not separate survivors and non survivors within the SIRS/sepsis group. However, the increase in iron and the decrease in CRP, from admission to discharge, was higher in survivors than in non-survivors within the SIRS/septic group (22.8 vs. 2.51 μg/dL respectively, p = 0.021 for iron; -67.1 vs. -4.1 mg/L respectively, p = 0.002 for CRP), resulting in discharge iron and CRP concentrations for survivors similar to those in the local inflammation group. The second study allowed us to conclude that hypoferremia is a sensitive marker of systemic inflammation in dogs. In this study, the increase in iron concentrations during the hospitalization period of SIRS/septic dogs was associated to a better prognosis, suggesting that plasma iron in combination with other biomarkers of inflammation such as CRP and albumin might be used to monitor the inflammatory process.