The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis
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...
Saved in:
| Main Authors: | , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2025-03-01
|
| Series: | Journal of Veterinary Internal Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1111/jvim.70044 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1850033936703422464 |
|---|---|
| author | Sarah M. Edwards Rebecka S. Hess |
| author_facet | Sarah M. Edwards Rebecka S. Hess |
| author_sort | Sarah M. Edwards |
| collection | DOAJ |
| description | 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 APPLEfull and median 5‐variable APPLEfast scores 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 APPLEfull score predicted mortality (p = 0.03). The AUC for the APPLEfull as a predictor of mortality was 0.67 and at the empirical optimal cutpoint of 23.5 the sensitivity and specificity of the APPLEfull score 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 APPLEfull score and BOHB predict mortality in dogs with DKA and can be used to stratify DKA dogs into appropriate survival groups. |
| format | Article |
| id | doaj-art-0fa1aec809794ef89ac6bc22baf03f14 |
| institution | DOAJ |
| issn | 0891-6640 1939-1676 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Veterinary Internal Medicine |
| spelling | doaj-art-0fa1aec809794ef89ac6bc22baf03f142025-08-20T02:58:00ZengWileyJournal of Veterinary Internal Medicine0891-66401939-16762025-03-01392n/an/a10.1111/jvim.70044The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic KetoacidosisSarah M. Edwards0Rebecka S. Hess1Department of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine University of Pennsylvania Philadelphia Pennsylvania USADepartment of Clinical Sciences and Advanced Medicine, School of Veterinary Medicine University of Pennsylvania Philadelphia Pennsylvania USAABSTRACT 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 APPLEfull and median 5‐variable APPLEfast scores 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 APPLEfull score predicted mortality (p = 0.03). The AUC for the APPLEfull as a predictor of mortality was 0.67 and at the empirical optimal cutpoint of 23.5 the sensitivity and specificity of the APPLEfull score 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 APPLEfull score and BOHB predict mortality in dogs with DKA and can be used to stratify DKA dogs into appropriate survival groups.https://doi.org/10.1111/jvim.70044APPLE scorebeta‐hydroxybutyratediabetes mellitusmortalityrisksurvival |
| spellingShingle | Sarah M. Edwards Rebecka S. Hess The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis Journal of Veterinary Internal Medicine APPLE score beta‐hydroxybutyrate diabetes mellitus mortality risk survival |
| title | The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis |
| title_full | The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis |
| title_fullStr | The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis |
| title_full_unstemmed | The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis |
| title_short | The Acute Patient Physiologic and Laboratory Evaluation Score and Other Prognostic Factors in Dogs With Diabetic Ketoacidosis |
| title_sort | acute patient physiologic and laboratory evaluation score and other prognostic factors in dogs with diabetic ketoacidosis |
| topic | APPLE score beta‐hydroxybutyrate diabetes mellitus mortality risk survival |
| url | https://doi.org/10.1111/jvim.70044 |
| work_keys_str_mv | AT sarahmedwards theacutepatientphysiologicandlaboratoryevaluationscoreandotherprognosticfactorsindogswithdiabeticketoacidosis AT rebeckashess theacutepatientphysiologicandlaboratoryevaluationscoreandotherprognosticfactorsindogswithdiabeticketoacidosis AT sarahmedwards acutepatientphysiologicandlaboratoryevaluationscoreandotherprognosticfactorsindogswithdiabeticketoacidosis AT rebeckashess acutepatientphysiologicandlaboratoryevaluationscoreandotherprognosticfactorsindogswithdiabeticketoacidosis |