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Published on: May 10, 2024
Comparative analysis of prognostic scoring systems for cats with suspected pancreatitis (472 cats)
Harry Cridge1, Julia Winser1, Julia Wells1
1Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States.
Background:
Various prognostic factors and schemes are proposed for use in cats with pancreatitis, but these have yet to be independently evaluated in a broad group of cats.
Hypothesis/Objectives:
(1) To compare predicted prognosis for death and prolonged (≥5 days) hospitalization across biochemical variables and composite schemes and (2) to calculate discriminatory ability for length of hospitalization.
Animals:
Four hundred seventy-two client-owned cats with suspected pancreatitis.
Methods:
Multi-institutional retrospective study (2019-2024). Prognostic factors included potassium, feline pancreas-specific lipase, total bilirubin, total calcium, and total magnesium. Prognostic schemes retrospectively calculated were the Acute Patient Physiologic and Laboratory Evaluation (APPLE)full and fast, and the modified feline activity index (MFAI).
Results:
Total calcium (median: 9.3 [IQR: 8.7-9.9] vs 9.6 [IQR: 9.0-10.1] mg/dL, P = .03), APPLEfull (median: 41 [IQR: 35-46] vs 36 [IQR: 30-40], P < .001), APPLEfast (median: 20.5 [IQR: 14.5-27.0] vs 14.0 [IQR: 12.0-19.0], P < .001), and MFAI (median: 5 [IQR: 4-8] vs 4 [IQR: 3-6], P = .011) were significantly different between fatal and nonfatal cases. Acute Patient Physiologic and Laboratory Evaluationfast had the greatest area under the curve for case fatality (0.695; 95% CI, 0.617-0.773) while MFAI had the greatest concordance index with length of hospitalization (0.673; 95% CI, 0.639-0.706). Overall negative predictive values were high and positive predictive values (PPVs) were low for both case fatality and prolonged hospitalization.
Conclusions And Clinical Importance:
Composite scoring schemes appear to be of greater prognostic value than individual variables in cats with pancreatitis. Because of the low PPVs for case fatality and prolonged hospitalization, prognostic factors should be interpreted cautiously on an individual cat basis and should not serve as the basis of clinically consequential decisions.
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