Peer-reviewed veterinary case report
Predicting death risk in dogs with diabetic ketoacidosis using APPLE
By Edwards, Sarah M & Hess, Rebecka S·Published in Journal of veterinary internal medicine·2025·Department of Clinical Sciences and Advanced Medicine, United States·View original on PubMed →
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Original publication title: The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis.
- Species:
- dog
Plain-English summary
A group of 85 dogs with diabetic ketoacidosis (DKA) was evaluated to see how certain scores and blood tests could predict their chances of survival. The study found that dogs who did not survive had higher APPLE scores (a measure of their overall health) and beta-hydroxybutyrate (a ketone level) compared to those that did survive. Specifically, a higher APPLE score indicated a greater risk of death, while certain levels of beta-hydroxybutyrate also helped predict mortality. These findings can help veterinarians assess the severity of DKA in dogs and make better treatment decisions.
People also search for: dog diabetic ketoacidosis symptoms · DKA treatment in dogs · what is APPLE score for dogs
Abstract
BACKGROUND: Acute patient physiologic and laboratory evaluation (APPLE) scores have not been reported in dogs with diabetic ketoacidosis (DKA). HYPOTHESIS: The APPLE scores will be higher in non-survivors compared with survivors, and higher scores will predict increased mortality in dogs with DKA. ANIMALS: Eighty-five dogs with DKA; 58 survivors (68%) and 27 non-survivors (32%). METHODS: Retrospective study. The APPLE scores were entered into a multivariate logistic regression model for mortality prediction. Variables related to DKA diagnosis also were examined as mortality predictors. If variables predicted mortality, an empirical optimal cut point, corresponding area under the receiver operating curve (AUC), and sensitivity and specificity for predicting mortality were calculated. RESULTS: Mean 10-variable APPLEand median 5-variable APPLEscores were higher in non-survivors (32 ± 10 and 11; range, 3-29, respectively) compared with survivors (25 ± 8; p < 0.001 and 7; range, 0-24; p = 0.02, respectively). The APPLEscore predicted mortality (p = 0.03). The AUC for the APPLEas a predictor of mortality was 0.67 and at the empirical optimal cutpoint of 23.5 the sensitivity and specificity of the APPLEscore for mortality prediction were 85% and 48%, respectively. Beta-hydroxybutyrate concentration (BOHB) also predicted mortality (p = 0.02). The AUC for BOHB as a mortality predictor was 0.75 and at the empirical optimal cutpoint of 4.75 the sensitivity and specificity of BOHB for mortality prediction were 58% and 92%, respectively. CONCLUSIONS AND CLINICAL IMPORTANCE: The APPLEscore and BOHB predict mortality in dogs with DKA and can be used to stratify DKA dogs into appropriate survival groups.
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Search related cases →Original publication on PubMed: https://pubmed.ncbi.nlm.nih.gov/40047391/