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Development of a severity scoring system for acute haemorrhage in anaesthetized domestic cats: the CABSS score
Gareth E Zeiler1, Andrea Fuller2, Eva Rioja3
1Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria, Pretoria, South Africa; Anaesthesia and Critical Care Services, Valley Farm Animal Hospital, Pretoria, South Africa; Brain Function Research Group, School of Physiology, University of the Witwatersrand, Johannesburg, South Africa.
Insights
Four physiological and biochemical ratios can predict severe hemorrhage in cats. The Cat Acute Bleeding Scoring System (CABSS) uses these ratios to quantify bleeding severity in anesthetized cats.
Area of Science:
- Veterinary Medicine
- Animal Physiology
- Critical Care
Background:
- Severe hemorrhage is a critical condition in cats.
- Predictive biomarkers for acute blood loss in feline patients are needed.
- Current diagnostic methods may not be sufficient for rapid assessment of hemorrhage severity.
Purpose of the Study:
- To identify physiological, haematological, biochemical, and electrolyte variables that predict severe hemorrhage in cats.
- To develop a scoring system for quantifying acute bleeding in feline patients.
Main Methods:
- A randomized crossover study involving six domestic cats subjected to mild and severe hemorrhage.
- Measurement of 34 variables pre- and post-hemorrhage.
- Calculation of variable ratios and analysis using receiver operating characteristic curves to develop the Cat Acute Bleeding Scoring System (CABSS).
Main Results:
- Heart rate, systolic arterial blood pressure, end-tidal carbon dioxide, serum albumin, haematocrit, and bicarbonate ion concentration were significant predictors.
- Four robust ratios, including shock index (HR:SAP) and HR:Pe'CO2, were identified.
- These ratios formed the basis of the proposed CABSS.
Conclusions:
- Statistically and clinically relevant changes were observed in cats experiencing mild versus severe hemorrhage.
- The developed CABSS, utilizing four key ratios, can detect and quantify severe hemorrhage in anesthetized cats.
- This scoring system offers a potential tool for improved clinical decision-making in cases of acute bleeding.
Objective:
To determine whether physiological, haematological, biochemical or electrolyte variables can predict severe haemorrhage in cats.
Study Design:
Randomized crossover study whereby each cat underwent mild and severe haemorrhage, with a 2 month period between events.
Animals:
A group of six domestic cats aged 21 ± 1 months and weighing 4.9 ± 1.2 kg, mean ± standard deviation.
Methods:
Cats were anaesthetized (buprenorphine, alfaxalone, isoflurane in oxygen at a fixed end-tidal concentration of 1.7%) before the haemorrhage event. In total, 34 variables were measured twice (prehaemorrhage and posthaemorrhage). The difference and percent change for each variable were compared between haemorrhage events (paired t test). Significant variables were placed into 13 different ratios (posthaemorrhage value of one variable divided by a posthaemorrhage value of a second variable) and compared (paired t test), and Cohen's d (d) was calculated. Receiver operating characteristic curves were plotted and cut-off values for weak, moderate and strong indicators of severe haemorrhage were obtained.
Results:
The blood loss was 4.5 ± 1.1 mL kg-1 and 26.8 ± 5.5 mL kg-1 for mild and severe haemorrhage events, respectively. The most significant variables with large effect sizes were heart rate (HR), systolic arterial blood pressure (SAP), end-tidal carbon dioxide (Pe'CO2), serum albumin, haematocrit and actual bicarbonate ion concentration [HCO3-(act)]. The most robust ratios were: 1) shock index (d = -2.8; HR:SAP); 2) HR:Pe'CO2 (d = -2.9); 3) serum albumin: haematocrit (d = 1.5); and 4) HR:HCO3-(act) (d = -1.6). These ratios were included in the final proposed Cat Acute Bleeding Scoring System (CABSS).
Conclusions:
and clinical relevance Cats subjected to mild and severe haemorrhage demonstrated statistically and clinically relevant changes whereby four ratios could be created to make up the CABSS. The ratios detected and quantified the presence of severe haemorrhage in anaesthetized cats.
