Serum amyloid A and plasma fibrinogen concentrations in horses following emergency exploratory celiotomy.
Authors: De Cozar M, Sherlock C, Knowles E, Mair T
Journal: Equine veterinary journal
Summary
# Editorial Summary: Acute-Phase Proteins as Predictors of Post-Operative Colic Surgery Outcomes De Cozar and colleagues examined whether serum amyloid A (SAA) and plasma fibrinogen concentrations could help predict complications and survival following emergency colic surgery, measuring these inflammatory markers before and daily for five days post-operatively in 300 horses undergoing exploratory celiotomy. Post-operative complications developed in 52% of cases, with significantly reduced survival odds in affected horses; notably, elevated fibrinogen at admission (OR 1.21) and strangulating lesions (OR 2.35) were independently associated with complication development. Both acute-phase proteins showed clinically meaningful patterns: SAA concentrations differed significantly between horses with and without complications on days 1–5, whilst fibrinogen diverged from day 3 onwards, with lower SAA at day 5 post-operatively correlating with improved survival prospects (OR 0.965 per unit decrease). The practical value of daily SAA monitoring and admission fibrinogen measurement lies in their potential to identify high-risk post-operative cases early, allowing intensified supportive care and closer clinical vigilance—particularly important given that 83.7% of horses survived to discharge overall, suggesting that intervention based on inflammatory markers could improve outcomes in the vulnerable 52% developing complications. However, the heterogeneity of colic lesions and post-operative complications in this cohort limited detailed mechanistic analysis, warranting further investigation into how these markers perform across specific surgical diagnoses.
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Practical Takeaways
- •Measuring serum amyloid A daily and fibrinogen at admission can help predict which colic surgery patients will develop post-operative complications
- •Horses with strangulating lesions and elevated pre-operative fibrinogen require closer monitoring and more intensive post-operative care
- •Persistently elevated serum amyloid A at 5 days post-surgery is a poor prognostic indicator; consider this in discharge planning and owner communication
Key Findings
- •52.0% of horses developed post-operative complications with significantly reduced survival (P<0.01)
- •Serum amyloid A at days 1, 4 and 5 and fibrinogen at days 3, 4 and 5 were significantly elevated in horses with post-operative complications (P<0.05)
- •Strangulating lesions (OR 2.35) and higher admission fibrinogen (OR 1.21) were associated with post-operative complications
- •Lower serum amyloid A at day 5 post-operatively was associated with survival to discharge (OR 0.965, P=0.002)