Escore APPLE felinos: Um sistema para estratificação de gravidade de doenças para felinos hospitalizados / The Feline Acute Patient Physiologic and Laboratory Evaluation (Feline APPLE) Score: A Severity of Illness Stratification System for Hospitalized Cats

The Feline Acute Patient Physiologic and Laboratory Evaluation (Feline APPLE) Score: A Severity of Illness Stratification System for Hospitalized Cats

1. G. Hayes¹, 
2. K. Mathews¹, 
3. G. Doig³, 
4. S. Kruth¹, 
5. S. Boston¹, 
6. S. Nykamp¹, 
7. Z. Poljak², 
8. C. Dewey²

Article first published online: 8 DEC 2010

DOI: 10.1111/j.1939-1676.2010.0648.x

Copyright © 2010 by the American College of Veterinary Internal Medicine

Issue

Journal of Veterinary Internal Medicine

Volume 25, Issue 1, pages 26–38, January/February 2011

Additional Information(Show All)

Keywords:

• Cats;
• health outcome assessment;
• Illness severity score;
• Intensive care unit

Background: Scores allowing objective stratification of illness severity are available for dogs and horses, but not cats. Validated illness severity scores facilitate the risk-adjusted analysis of results in clinical research, and also have applications in triage and therapeutic protocols.

Objective: To develop and validate an accurate, user-friendly score to stratify illness severity in hospitalized cats.

Animals: Six hundred cats admitted consecutively to a teaching hospital intensive care unit.

Methods: This observational cohort study enrolled all cats admitted over a 32-month period. Data on interventional, physiological, and biochemical variables were collected over 24 hours after admission. Patient mortality outcome at hospital discharge was recorded. After random division, 450 cats were used for logistic regression model construction, and data from 150 cats for validation.

Results: Patient mortality was 25.8%. Five- and 8-variable scores were developed. The 8-variable score contained mentation score, temperature, mean arterial pressure (MAP), lactate, PCV, urea, chloride, and body cavity fluid score. Area under the receiver operator characteristic curve (AUROC) on the construction cohort was 0.91 (95% CI, 0.87–0.94), and 0.88 (95% CI, 0.84–0.96) on the validation cohort. The 5-variable score contained mentation score, temperature, MAP, lactate, and PCV. AUROC on the construction cohort was 0.83 (95% CI, 0.79–0.86), and 0.76 (95% CI, 0.72–0.84) on the validation cohort.

Conclusions and Clinical Importance: Two scores are presented enabling allocation of an accurate and user-friendly illness severity measure to hospitalized cats. Scores are calculated from data obtained over the 1st 24 hours after admission, and are diagnosis-independent. The 8-variable score predicts outcome significantly better than does the 5-variable score.