Re-evaluation of the sepsis score in equine neonates

SummaryReasons for performing study The modified sepsis scoring system provides a method to identify sepsis in foals early in the disease process, but inconsistent results have been obtained from its clinical application in previous studies. Objectives To evaluate the sensitivity and specificity of the modified sepsis score in a larger population of foals. A secondary objective was to identify factors associated with sepsis. Study design Retrospective cohort study. Methods Records were retrospectively analysed for neonatal admissions to the University of Florida Large Animal Hospital from 1982 to 2008. Backwards stepwise multivariable logistic regression was used to evaluate objective clinical factors associated with sepsis. Receiver operating chararacteristic ROC curve analysis was performed on the modified sepsis score and used to determine an optimal cut point. Results A total of 1065 foals were included in the study. The modified sepsis score had a sensitivity of 56.4% and specificity of 73.4% for the originally suggested cut point (>11). Receiver operating chararacteristic analysis revealed an optimal cut point of >7 (sensitivity 84.4%, specificity 41.8%). The modified sepsis score performed better than the generated regression model which included age, creatinine, lymphocytes, potassium and IgG>8 g/l (P = 0.026). Diagnostic performance of the modified sepsis score did not change significantly over time. Conclusions Sensitivity and specificity of the modified sepsis score were not as high as previously documented, but the score still outperformed a regression model derived from objective clinical data. The Summary is available in Chinese – see Supporting information.