Alterations in the hemostatic profiles of dogs with naturally occurring septic peritonitis.

Abstract

OBJECTIVE: To characterize derangements in the hemostatic profiles of dogs with naturally occurring septic peritonitis and determine if such derangements were predictive of survival. DESIGN: Prospective, observational single cohort study. SETTING: University veterinary teaching hospital. ANIMALS: A total of 27 client-owned dogs with naturally occurring septic peritonitis. INTERVENTIONS: Standard treatment included fluid resuscitation, antimicrobial therapy, supportive care, and surgery provided at the discretion of the primary clinician. Blood was collected preoperatively and on days 1 and 3 postoperatively for platelet count, prothrombin time, activated partial thromboplastin time, D-dimer and fibrinogen concentrations, total protein C (PC) and antithrombin (AT) activities, and thromboelastography. MEASUREMENTS AND MAIN RESULTS: Sixteen of 27 (59%) dogs survived. Preoperative PC deficiency was identified in 10 of 11 (91%) nonsurvivors and 2 of 15 (13%) survivors. Preoperative AT deficiency was identified in 10 of 11 (91%) nonsurvivors and 14 of 15 (93%) survivors. Compared to survivors, nonsurvivors had lower mean preoperative PC (98 &#xb1; 24% versus 49 &#xb1; 26%; P < 0.001) and AT (53 &#xb1; 9% versus 32 &#xb1; 16%; P < 0.001) activities. Anticoagulant activities decreased on day 1 postoperatively. As a predictor of survival, preoperative PC activity of more than 60% achieved a sensitivity of 93% and specificity of 82%. Preoperative AT activity of more than 41.5% achieved a sensitivity of 100% and specificity of 82%. The maximum amplitude, &#x3b1; angle, and coagulation index from preoperative thromboelastograms of survivors were significantly greater (more hypercoagulable) than nonsurvivors (P < 0.01), with the maximum amplitude being the most specific predictor of survival (100%). CONCLUSIONS: Deficiencies of PC and AT and hypercoagulability appear to be consistent features of naturally occurring canine sepsis and may be useful prognostic indicators in canine septic peritonitis.