Evaluation of sequential serum amyloid A measurements for the prediction of sepsis and survival in critically ill neonatal foals.

SAA at 419 μg/mL offers moderate sepsis screening utility but should not be used as a standalone diagnostic or prognostic marker in critically ill neonatal foals.

This prospective cohort study evaluated whether sequential serum amyloid A (SAA) measurements during the first 48 hours of hospitalization could improve prediction of sepsis and death in 127 critically ill neonatal foals under 14 days of age. SAA was measured at admission (day 0, n=127) and on day 2 (n=97) using a validated point-of-care assay. Logistic regression and Cox survival analyses were used to assess predictive value. At admission, SAA was significantly associated with neutropenia, positive blood cultures, or both, with an optimal cut-off of 419 μg/mL yielding moderate sensitivity and specificity (80% and 81%, respectively). However, SAA was not significantly associated with mortality at either time point. Critically, the change in SAA concentration between day 0 and day 2 did not significantly predict death, neutropenia, blood culture positivity, or a composite sepsis definition. These findings indicate that serial SAA measurements over 48 hours do not offer meaningful diagnostic or prognostic improvement over single admission values in critically ill neonatal foals. While SAA shows some utility as a marker for sepsis screening at a threshold of 419 μg/mL, its moderate diagnostic accuracy and inability to predict survival limit its standalone clinical utility. The authors conclude that SAA should be interpreted as part of a broader diagnostic panel rather than used in isolation for sepsis diagnosis or mortality prediction in this population.

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