Survival rates and factors associated with survival and laminitis of horses with acute diarrhoea admitted to referral institutions.
Authors: Gomez Diego E, Dunkel Bettina, Renaud David L, Arroyo Luis G, Schoster Angelika, Kopper Jamie J, Byrne David, Toribio Ramiro E
Journal: Equine veterinary journal
Summary
# Acute Diarrhoea in Horses: Prognostic Indicators and Geographic Variation in Laminitis Risk This large multicentre retrospective analysis examined 1,438 horses with acute diarrhoea presenting to 26 referral institutions across four continents between 2016 and 2020, establishing an overall survival rate of 76% with consistent outcomes across geographic regions. Elevated creatinine (>159 µmol/L) and L-lactate (>2.8 mmol/L) concentrations in horses presenting with systemic inflammatory response syndrome (SIRS) were strong negative prognostic indicators, reducing survival probability from approximately 81% to 55–59% respectively—markers reflecting the degree of cardiovascular compromise and disease severity. Interestingly, secondary laminitis developed in a notably higher proportion of horses in North America (8%), Australia (8%) and Latin America (11%) compared with European cases (4%), and showed distinct seasonal clustering with 46% of laminitis cases occurring in summer months versus 18–19% across other seasons. Horses that developed laminitis had 3.73 times greater odds of non-survival than those without, emphasising laminitis as a serious complication rather than merely a concurrent finding. For practitioners managing diarrhoeic cases, these findings highlight the clinical utility of creatinine and lactate measurements for prognostication, whilst also suggesting that geographic differences in laminitis incidence may warrant investigation into regional management protocols, antimicrobial stewardship patterns, or environmental factors affecting disease expression.
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Practical Takeaways
- •Monitor creatinine and L-lactate concentrations in diarrheal horses with SIRS as markers of disease severity and prognosis; levels above 159 μmol/L and 2.8 mmol/L respectively indicate significantly poorer survival outcomes
- •Be aware that laminitis development secondary to acute diarrhea is a serious complication associated with 3.7-fold increased mortality risk; maintain heightened vigilance during summer months when incidence peaks
- •Geographic region should not influence prognostic expectations for diarrheal horses, but European practitioners may encounter laminitis complications less frequently than colleagues in North America, Australia, and Latin America
Key Findings
- •Overall survival rate was 76% across all geographic regions with no significant differences between regions
- •Horses with SIRS and creatinine >159 μmol/L had 55% survival compared to 81% survival in those with creatinine <159 μmol/L
- •Horses with SIRS and L-lactate >2.8 mmol/L had 59% survival compared to 81% in those with L-lactate <2.8 mmol/L
- •Laminitis development was significantly lower in Europe (4%) compared to North America (8%), Australia (8%), and Latin America (11%), and was more common in summer (46%) than other seasons
- •Horses that developed laminitis secondary to diarrhea had 3.73 times greater odds of non-survival