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Avaliação do uso do índice de atividade canina modificado (MCAI) como ferramenta para prever a morte em cães com pancreatite : a propósito de 248 casos clínicos
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O prognóstico da pancreatite canina é variável e de difícil previsão: alguns animais apresentam evolução benigna, enquanto outros progridem para quadros graves, frequentemente associados a elevada mortalidade. Nesse contexto, o presente estudo teve como objetivo avaliar o Índice de Atividade Canina Modificado (MCAI) numa amostra de 248 cães com pancreatite, como ferramenta para prever a mortalidade. Este índice, baseado nos sinais clínicos observados, revelou-se particularmente adequado para aplicação num estudo retrospetivo. Depreendeu-se que a utilização do MCAI pode ser de grande utilidade para o médico veterinário, por ser rápido, não invasivo e baseado em variáveis facilmente obtidas durante a consulta, como a atividade, apetite, vómito, dor abdominal cranial, desidratação, consistência e presença de sangue nas fezes. Cada variável recebe uma pontuação entre 0 e 3, com exceção da presença de sangue nas fezes, cuja pontuação varia entre 0 e 1. Após a definição de um cut-off ideal, através da construção e análise de uma curva ROC (Receiver Operating Characteristic), obtiveram-se os seguintes resultados: 60 verdadeiros positivos e 97 falsos positivos, resultando num valor preditivo positivo de 38%, IC 95% [34%-42%]. Foram ainda identificados 81 verdadeiros negativos e 10 falsos negativos, correspondendo a um valor preditivo negativo de 90%, IC95% [83%-94%]. Desse modo, o MCAI demonstrou uma sensibilidade de 87%, IC 95% [77%-94%] e uma especificidade de 45%, IC 95% [38%-53%] na previsão de um desfecho fatal nesta amostra. Tais resultados permitem concluir que o MCAI é especialmente adequado como exame de triagem em animais com suspeita de pancreatite. Valores abaixo do cut-off de 5 associaram-se a maior probabilidade de sobrevivência, enquanto valores iguais ou superiores a 5 indicaram risco acrescido de morte
The prognosis of canine pancreatitis is variable and difficult to predict: some animals present a benign course, while others progress to severe conditions, often associated with high mortality. In this context, the present study aimed to evaluate the Modified Canine Activity Index (MCAI) in a sample of 248 dogs with pancreatitis, as a tool to predict mortality. This index, based on clinical signs, proved to be particularly suitable for application in a retrospective study. It was found that the use of the MCAI may be highly useful for veterinarians, as it is rapid, non-invasive, and based on variables easily obtained during clinical examination, such as activity, appetite, vomiting, cranial abdominal pain, dehydration, fecal consistency, and presence of blood in the feces. Each variable is scored from 0 to 3, except for the presence of blood in the feces, which is scored from 0 to 1. After defining an optimal cut-off, the following results were obtained: 60 true positives and 97 false positives, resulting in a positive predictive value of 38%, IC 95% [34%-42%]. In addition, 81 true negatives and 10 false negatives were identified, corresponding to a negative predictive value of 90%, IC95% [83%-94%]. Thus, the MCAI demonstrated a sensitivity of 87%, IC 95% [77%-94%] and a specificity of 45%, IC 95% [38%-53%] in predicting a fatal outcome in this sample. These results suggest that the MCAI is especially suitable as a screening tool in animals with suspected pancreatitis. Values below the cut-off of 5 were associated with a high probability of survival, whereas values equal to or above 5 indicated an increased risk of death
The prognosis of canine pancreatitis is variable and difficult to predict: some animals present a benign course, while others progress to severe conditions, often associated with high mortality. In this context, the present study aimed to evaluate the Modified Canine Activity Index (MCAI) in a sample of 248 dogs with pancreatitis, as a tool to predict mortality. This index, based on clinical signs, proved to be particularly suitable for application in a retrospective study. It was found that the use of the MCAI may be highly useful for veterinarians, as it is rapid, non-invasive, and based on variables easily obtained during clinical examination, such as activity, appetite, vomiting, cranial abdominal pain, dehydration, fecal consistency, and presence of blood in the feces. Each variable is scored from 0 to 3, except for the presence of blood in the feces, which is scored from 0 to 1. After defining an optimal cut-off, the following results were obtained: 60 true positives and 97 false positives, resulting in a positive predictive value of 38%, IC 95% [34%-42%]. In addition, 81 true negatives and 10 false negatives were identified, corresponding to a negative predictive value of 90%, IC95% [83%-94%]. Thus, the MCAI demonstrated a sensitivity of 87%, IC 95% [77%-94%] and a specificity of 45%, IC 95% [38%-53%] in predicting a fatal outcome in this sample. These results suggest that the MCAI is especially suitable as a screening tool in animals with suspected pancreatitis. Values below the cut-off of 5 were associated with a high probability of survival, whereas values equal to or above 5 indicated an increased risk of death
Descrição
Dissertação de Mestrado Integrado em Medicina Veterinária, área científica de Clínica
Palavras-chave
Pancreatite Cães Prognóstico Mortalidade Sensibilidade Pancreatitis Dogs Prognosis Mortality Sensitivity