Development of a prognostic scoring system for systemic inflammatory response syndrome in donkeys

BACKGROUND: Systemic inflammatory response syndrome (SIRS) is associated with increased mortality in horses with gastrointestinal (GI) disease. However, there are no data relating to naturally occurring SIRS in donkeys. OBJECTIVES: To determine SIRS frequency in donkeys with GI disease. To develop a donkey-specific prognostic SIRS score. STUDY DESIGN: Retrospective case series. METHODS: Clinical records from donkeys presenting with GI disease in two independent cohorts (development cohort: n = 400, UK; validation cohort: n = 36, Australia) were reviewed. Age, sex, heart rate, respiratory rate, rectal temperature, white blood cell count (WBCC), neutrophil%, neutrophil count, packed cell volume (PCV), total protein (TP), PCV/TP ratio, triglycerides, albumin, creatinine, urea, serum amyloid A, and outcome were recorded. SIRS scores validated for horses (hSIRS, 0-4) were calculated. Prognostic factors were identified in the development cohort using generalised estimating equations and receiver operator characteristic analysis. A novel donkey SIRS score (dSIRS, 0-6) was developed and applied to the second cohort for validation. A traffic light system was further devised to classify individuals as low-, medium-, and high-risk of non-survival. RESULTS: /L) were significant predictors of outcome. The dSIRS score included heart rate, WBCC, age (15-25; or >25 years), PCV/TP ratio (>0.5725), and [triglyceride] (>2.8 mmol/L). In the development cohort, the dSIRS score predicted outcome with 78.3% accuracy (sensitivity: 62.7% [95% CI: 51.9-72.3]; specificity: 83.5% [78.4-87.5]). In the validation cohort, accuracy was 81% (sensitivity: 100% [79.6-100.0], specificity: 47.6% [28.3-67.6]). MAIN LIMITATIONS: Retrospective study, small validation cohort. CONCLUSIONS: The frequency of SIRS and associated fatality rate in donkeys with GI disease is high. After further validation through a prospective study, the dSIRS score could be a valuable prognostic tool.