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 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 APPLE_full and median 5-variable APPLE_fast 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 APPLE_full score predicted mortality (p = 0.03). The AUC for the APPLE_full as a predictor of mortality was 0.67 and at the empirical optimal cutpoint of 23.5 the sensitivity and specificity of the APPLE_full 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 APPLE_full score and BOHB predict mortality in dogs with DKA and can be used to stratify DKA dogs into appropriate survival groups.