Sepsis in critically ill dogs: identification of clinical and laboratory risk factors and evaluation of sepsis scoring systems.

The APPLE FAST score best predicts sepsis and mortality in critically ill dogs presenting with dyspnea, tachypnea, or elevated ALT.

This prospective single-center cohort study investigated risk factors for sepsis in 130 critically ill dogs and evaluated the diagnostic and prognostic utility of existing scoring systems. Sepsis was confirmed in 29 dogs (22.3%), with a notably high short-term mortality rate of 62.1% (18 deaths). Univariable analysis identified pneumonia (OR=4.8) and acute kidney injury (AKI; OR=7.4) as conditions significantly associated with sepsis. Multivariable logistic regression revealed dyspnea (OR=6.5), respiratory rate ≥38 breaths/minute (OR=3.9), and alanine aminotransferase (ALT) activity ≥109.5 U/L (OR=3.8) as independent risk factors. When combined, these variables demonstrated high specificity (92.8%) but limited sensitivity (35.0%). A classification and regression tree (CART) analysis offered improved sensitivity (58.6%) with very high specificity (97.0%), identifying body weight, tachypnea, hypotension, hyperchloremia, hyperlactatemia, and hyponatremia as key discriminators. Among evaluated scoring systems, the APPLE FAST score was associated with both sepsis diagnosis (OR=2.9) and short-term mortality (OR=3.2), making it the strongest prognostic tool identified. These findings provide clinically actionable criteria to aid veterinarians in the early identification of sepsis in critically ill dogs. Integration of respiratory parameters, hepatic markers, and the APPLE FAST score into clinical decision-making may improve triage, guide therapeutic interventions, and help prognosticate outcomes in canine emergency and critical care settings.

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