Right dorsal colitis in horses: A multicenter retrospective study of 35 cases
Jordan FloodDavid ByrneJenni BauquierGustavo Ferlini AgneJessica C. WiseCarlos E. Medina‐TorresKelly WoodOlivia SullivanAllison J. Stewart
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Abstract Background Right dorsal colitis (RDC) is a nonsteroidal anti‐inflammatory drug (NSAID) induced, protein losing enteropathy in horses associated with a high case fatality rate. Objectives To describe signalment, NSAID usage, clinical presentations, clinical pathology, ultrasonographic findings, treatments, outcomes, and factors associated with survival in horses diagnosed with RDC. Animals Thirty‐five horses from 7 Australian equine hospitals diagnosed with RDC. Methods Retrospective case series. Clinical records of cases were accepted if definitively or presumptively diagnosed by an internist with RDC and had ≥3 of: hypoproteinemia or hypoalbuminemia; diarrhea with negative test results for infectious diseases; colic for which other diseases were excluded or right dorsal colon thickening on ultrasound. Descriptive data analysis was performed for categorical and continuous variables. Univariate binominal logistic regressions were used to assess factors associated with survival. Results An overdose of NSAIDs occurred in 84% (21/25) cases where dose was known. Common clinical presentations included diarrhea (69%; 22/32), colic (61%; 20/33), and tachycardia (53%, 17/32). Common clinicopathological findings included hypoalbuminemia (83%; 26/31), hypocalcaemia (79%, 23/29), and hyperlactatemia (77%, 14/18). The right dorsal colon wall appeared subjectively thickened in 77% (24/31) cases using ultrasonography. Case fatality rate was 43% (15/35). Odds of survival significantly decreased with increasing heart rate (odds 0.84, 95% CI = 0.71‐0.92, P = .01), packed cell volume (odds 0.91, 95% CI 0.82‐0.98, P = .05) and abnormal appearance of mucous membranes (odds 0.05, 95% CI 0.005‐0.28, P = .001) on hospital presentation. Conclusions and Clinical Importance An overdose of NSAIDs is common in horses diagnosed with RDC. Serum albumin concentrations should be monitored in horses receiving a prolonged course of NSAIDs. Overall prognosis for RDC remains fair.Keywords:
Hypoalbuminemia
Hypoproteinemia
Univariate analysis
Hypoproteinemia
Hypoalbuminemia
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Hypoproteinemia is a common clinical complication in many diseases, which could affect the disease prognosis, particularly in critical illness. Low serum albumin level often precludes dangerous conditions and poor prognosis. In the pediatric clinical practice, hypoalbuminemia is commonly seen in acute infection. Therefore, the mechanism of infection-induced hypoalbuminemia should be emphasized, which plays a crucial role in modifying clinical interventions and reducing the mortality rate. But the mechanism of hypoalbuminemia has not yet been fully clarified at present. In this article,the possible mechanism of infectioninduced hypoproteinemia is investigated from the albumin catabolism, synthesis, distribution of abnormalities,half-life, protein-losing enteropathy and so on.
Key words:
Hypoproteinemia; Infectious diseases; Pathogenesis
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To examine the characteristics and the prognostic influence of pulmonary infections in neurologic disease patients with mild-to-severe hypoproteinemia.We used a retrospective survey method to analyze the characteristics and prognoses of 220 patients with hypoproteinemia complicated with pulmonary infection in the Internal Medicine-Neurology Intensive Care Unit at the First Affiliated Hospital of Chongqing Medical University from January 2010 to December 2013. The patients were divided into mild, moderate and severe hypoproteinemia groups according to their serum albumin levels. The analysis included patient age, sex, acute physiology and chronic health evaluation (APACHE II score), and characteristics of the pulmonary infection, nutritional support and prognosis, among others.Differences in the general information of the 220 cases of hypoalbuminemia patients complicated with varying degrees of pulmonary infection (APACHE II score, age, disease distribution) were statistically significant. The pulmonary infection onset time and pathogen susceptibility in the patients with mild-to-severe hypoalbuminemia were not significantly different. Pulmonary infection onset was more frequently observed within the first 3-11 days following admission in all groups. The nutritional support method did not significantly influence serum albumin protein levels. However, the neurological intensive care unit stay length, total hospitalization cost and disease distribution were significantly different among the patient groups.Patients with cerebrovascular disease, intracranial infections and epilepsy complicated with pulmonary infection represent the high-risk groups for hypoalbuminemia. The Acinetobacter baumannii complex represents the main group of pathogenic bacteria causing lung infections, and the high-risk period for lung infections is 3-11 days after the occurrence of hypoalbuminemia. Patients with severe hypoalbuminemia complicated with pulmonary infection have the worst prognoses.
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Objective
To investigate adverse pregnancy outcomes of pregnant women with hypoproteinemia in the third trimester and its influencing factors.
Methods
A total of 86 cases of pregnant women who were diagnosed as hypoalbuminemia in the third trimester in the Tongzhou Maternal & Child Health Hospital from January 2011 to July 2014 were included into this study. All of those 86 cases of pregnant women were divided into severe hypoalbuminemia groups (Ⅰ group, n=39) and mild hypoalbuminemia group (Ⅱ group, n=47) according to serum albumin levels. At the same time, 50 cases of healthy pregnancy women in the third trimester were chosen as control group (n=50). There was no significant difference among three groups in the aspect of mean age (P>0.05). The adverse pregnant results, indexes of biochemical examination, and constituent ratio of main diseases of pregnant women with hypoalbuminemia during the third trimester were analyzed. Furthermore, correlation between eclampsism and hypoproteinemia, non-conditional multivariate logistic regression analysis were also analyzed. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Tongzhou Maternal & Child Health Hospital. Informed consent was obtained from each patient.
Results
① The main disease of pregnant women with hypoalbuminemia during the third trimester was preeclampsia (53.5%), followed by liver diseases (12.8%) and multiple pregnancies (11.6%). There were significant differences among preeclampsia pregnant women, non-preeclampsia pregnant women and control group in serum total protein, albumin and prealbumin (PA) (P<0.05). ② There were significant differences among Ⅰgroup, Ⅱ group and control group in total protein, albumin, PA, uric acid, alamine aminotransferase (ALT), lactate dehydrogenase (LDH), serum creatinine, blood urea nitrogen (BUN), Mg2+ , triglyceride (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C) (P<0.05). And the incidence rates of preterm birth, fetal growth restriction, placental abruption and other adverse pregnancy outcomes inⅠ group were higher than those in Ⅱ group and control group, with significant differences (P<0.05). ③Non-conditional multivariable logistic regression analysis showed that hypoalbuminemia was the highest risk factor of adverse pregnancy outcomes among pregnant women with hypoproteinemia in the third trimester (OR=1.261, P<0.05).
Conclusions
Preeclampsia plays an important role in the progress of pregnant women with hypoproteinemia in the third trimester. Pregnant women with hypoalbuminemia often accompanied by a variety of abnormal biochemical indicators and adverse pregnant outcomes. Early clinical evaluation of pregnant women with hypoalbuminemia in the third trimester has important significance for avoiding or descresing the incidence rate of adverse pregnant outcomes.
Key words:
Hypoproteinemia; Pregnancy trimester, third; Pregnancy outcome; Risk factors
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<p><strong>Aim <br /></strong>To investigate the relationship between preoperative level of serum albumin in patients with colorectal cancer (CRC), stage of CRC and postoperative complications.<br /><strong>Methods</strong> <br />This cross-sectional retrospective study was conducted at the Clinic for General and Abdominal Surgery of the University<br />Clinical Centre Sarajevo (UCCS). A total of 107 patients surgically treated for CRC in the period between 2013 and 2018 were enrolled in this study and divided into two groups: with hypoalbuminemia (group A) and without hypoalbuminemia (group B).<br /><strong>Results</strong> <br />The average level of albumin in group A was 29 (25-32) g/L versus 39 (37-41) g/L in group B (p&lt;0.05). The average length of hospital stay in group A was 18 (13-25) days, and in group B 14.5 (12-21) days. Patients with hypoalbuminemia (group A) had wound dehiscence more often and more re-interventions compared to group B (p&lt;0.05). Binary logistic regression found that serum protein, albumin and globulin levels were not statistically significant in the prediction of CRC stadium or postoperative complications (p&gt;0.05).<br /><strong>Conclusion</strong> <br />Study results show that preoperatively measured levels of serum albumin are not associated with the stage of colorectal cancer and cannot serve as predictors for postoperative complications.</p>
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Hypoproteinemia is a common clinical manifestation,which could affect prognosis of many diseases.It is an important prediction index of mortality,morbidity in critically ill children.Serum albumin level is closely related to the severity and mortality.In pediatric practice,hypoalbuminemia is also seen as a common feature of acute infection.Therefore,the clinical interventions of hypoalbuminemia in critically ill children should be emphasized,which plays a crucial role in reducing the mortality rate.At present,the pathogenesis of hypoalbuminemia has not yet been fully clarified,so the treatment of hypoproteinemia still remains controversy.In this article,the clinical significance,pathogenesis and treatment of childhood hypoalbuminemia are reviewed.
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Aim: This study examines the association of decreased levels of serum proteins with the occurrence of Clostridium difficile-associated diarrhea (CDAD) in hospitalized patients. Materials & methods: This is a retrospective case–control study using a case cohort (n = 171) that had been described in an earlier study and a cohort of 332 contemporaneous controls. Results: Patients with CDAD had significantly lower serum levels of albumin, total protein and globulins, and decreased albumin/globulin ratio (p < 0.0001 for all parameters). After adjustment for confounders, hypoproteinemia was more closely associated with CDAD than either hypoalbuminemia or albumin/globulin ratio. Hypoproteinemia exhibited an odds ratios of 10.6 (95% CI: 6.62–17.0) after adjustment for race, and 11.0 (95% CI: 6.88–17.1) after adjustment for age. Conclusion: Decreased total serum protein is more closely associated with CDAD than hypoalbuminemia.
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The present retrospective study was undertaken to determine the frequency of hypoproteinemia and hypoalbuminemia in horses with natural occurring severe liver disease. The study represents a review of case records and laboratory data of 84 horses presented with acute or chronic liver disease to the University of California Veterinary Medical Teaching Hospital between 1973 and 1991. Forty horses (48%) had serum protein concentrations above the maximum reference value (7.7 g/dL). The increase in serum protein concentration was associated with hyperglobulinemia (P = .00005, R2 = .80). Only 13% (11/84) of the horses had serum albumin concentrations below the minimum reference range (2.5 g/dL), and hypoproteinemia was found in only 1 of these horses. Of these, 18% (9/51) of the horses with chronic liver disease and 6% (2/33) of the horses with acute liver disease had albumin concentrations below the minimum reference value. Globulin concentrations in 64% of the horses (54/84) were above the maximum reference value (4.0 g/dL). The present study indicates that hypoproteinemia and hypoalbuminemia are not common features in horses with severe liver disease.
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Objective:To study the correlation between hypoalbuminemia and prognosis in aged patients with chronic heart failure(CHF).Methods:A total of 102 aged CHF patients with cardiac function of C or D grade were divided into hypoproteinemia group and normal control group according serum albumin level.The mean time in hospital,incidence of cardiac function D grade,mortality rate were analyzed between two groups.Results: The patients with hypoproteinemia occupied 52.9%.Compared with normal control group,the hypoproteinemia group had more D grade of CHF(29.2% vs.74.0%,P0.01)and longer time in hospital [(20.3±11.7)d vs.(29.7±19.2)d,P0.05).But there was no significant different in mortality rate between two groups(P0.05).Conclusion:.The severity degree of CHF is related to hypoalbuminemia,so must pay great attention for it.
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