Prognostic value of clinicopathologic variables obtained at admission and effect of antiendotoxin plasma on survival in septic and critically ill foals.
Authors: Peek Simon F, Semrad Sue, McGuirk Sheila M, Riseberg Ase, Slack Jo Ann, Marques Fernando, Coombs Dane, Lien Laura, Keuler Nicholas, Darien Benjamin J
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary This prospective trial evaluated 68 critically ill and septic foals to identify admission variables predicting survival and to compare outcomes between two plasma types. All foals received standardised clinical assessment at admission including haematology, biochemistry and coagulation profiles; they were then randomly allocated to either conventional hyperimmune equine plasma or antiendotoxin-enriched plasma in blinded fashion. Foals presenting with sepsis scores ≤11 and no bacteraemia achieved excellent survival (95%), whilst truly bacteremic foals showed considerably worse prognosis at 58%, though antiendotoxin plasma improved overall survival significantly (OR 6.76; P=0.012) and specifically in septic cases (OR 6.27; P=0.019). Among the 53 variables analysed, elevated sepsis score, low IgG, high fibrinogen, low segmented neutrophil count and low red blood cell numbers emerged as the strongest independent predictors of mortality. These findings support careful interpretation of sepsis scoring systems as diagnostic tools for bacteraemia (sensitivity 74%, specificity 52%) and suggest that plasma selection may meaningfully influence outcomes in critical foal cases, with antiendotoxin-enriched preparations warranting consideration where sepsis is suspected.
Read the full abstract on PubMed
Practical Takeaways
- •Consider using antiendotoxin antibody-rich equine plasma in septic foals, as it demonstrates a 6-fold improvement in survival odds over conventional hyperimmune plasma
- •Admission sepsis scoring, IgG levels, fibrinogen, neutrophil counts, and RBC numbers can help prognosticate critically ill foals—high sepsis scores combined with low IgG warrant aggressive intervention
- •Non-septic critically ill foals have excellent prognosis (95% survival), while truly bacteremic foals remain challenging cases requiring plasma therapy and supportive care
Key Findings
- •Overall survival rate was 72% (49/68), with septic foals having 57% survival compared to 95% in non-septic foals
- •Antiendotoxin antibody-rich plasma significantly improved survival in the entire population (OR 6.763, P=0.012) and in septic foals specifically (OR 6.267, P=0.019)
- •High sepsis score, low IgG concentration, high fibrinogen, low segmented neutrophil count, and low red blood cell numbers were independent predictors of mortality
- •Sepsis score >11 had 74% sensitivity and 52% specificity for predicting bacteremia in critically ill foals