Serum amiloid a düzeyleri piyometralı kedilerde SİRS tanısında kullanılabilir mi?

Öz

Serum amiloid A (SAA) düzeyi enfeksiyon, doku hasarı ve travma gibi durumlarda artar ve bir hastalığa özgü olmamakla birlikte inflamasyonun varlığı ve şiddeti hakkında bilgi verir. Hayatı tehdit eden bir durum olan pyometra genellikle sistemik inflamatuar yanıt sendromuna (SIRS) neden olur ve bu nedenle SAA seviyelerinde artışa yol açabilir. Bu çalışma, SIRS gelişen piyometralı kedilerde SAA düzeylerini belirlemek ve SAA’nın tanısal değerini hematolojik ve biyokimyasal parametrelerin yanı sıra SIRS kriterleriyle karşılaştırarak göstermek amacıyla tasarlanmıştır. Bu amaçla SIRS geliştirdiği tespit edilen ve hastanemize getirilen açık serviks pyometralı (OP, n=6) ve kapalı serviks pyometralı (CP, n=6) kedilerin yanı sıra rutin kısırlaştırma için getirilen ve seksüel siklusun diöstrus döneminde olduğu tespit edilen sağlıklı kedilerden (DE, n=6) elde edilen veriler kullanılmıştır. Piyometralı kediler, DE grubundaki kedilere kıyasla daha yüksek SAA seviyelerine ve lökositoza sahiptir (sırasıyla P= 0,002 ve P= 0,000). En yüksek SAA seviyesi CP grubunda tespit edilmiştir (168,6 µg/ml) ve bu seviye diğer gruplardakine göre istatistiksel olarak anlamlı bulunmuştur (P= 0,028). SAA düzeyleri ile SIRS kriterleri arasında korelasyon saptanmazken, SAA düzeyleri hem AST (P= 0,045, rs=-0,478) hem de GGT (P= 0,019 rs= -0,548) ile negatif korelasyon göstermiştir. Çalışmada sepsis ve SIRS'in kedilerde farklı semptomlarla ilerlediği, SIRS kriterlerinin kedilerde köpeklere göre daha az spesifik olduğu tespit edilmiştir. Serum amilod A’nın CP olgularında önemli bir belirteç olabileceği sonucuna varılmıştır. Çalışma verilerinin umut verici olduğunu ancak çalışmaya dahil edilen hasta sayısı göz önünde bulundurulduğunda daha ileri ve kapsamlı çalışmalara ihtiyaç olduğunu düşünmekteyiz.

Anahtar Kelimeler

• Kedi
• piyometra
• serum amiloid A
• sistemik yangısal cevap sendromu

Can serum amyloid A levels be used in the diagnosis of SIRS in cats with pyometra?

Abstract

Serum amyloid A (SAA) level increases in conditions such as infection, tissue damage and trauma and is not specific to a disease but provides information about the presence and severity of inflammation. As a life-threating conditions pyometra usually causes systemic inflammatory response syndrome (SIRS) and therefore may lead an increase in SAA levels. The present study was designed to determine SAA levels in cats with pyometra that developed SIRS, and to demonstrate the diagnostic value of SAA by comparing it with hematological and biochemical parameters as well as SIRS criteria. For this purpose, data were used from cats with open-cervix pyometra (OP, n=6) and closed-cervix pyometra (CP, n=6), which were identified as having developed SIRS and were admitted to hospital as well as from healthy cats brought in for routine neutering, which were identified to be in the diestrus phase of the sexual cycle (DE, n=6). Cats with pyometra had higher SAA levels and leukocytosis compared to cats in the DE group (P= 0.002 and P= 0.000, respectively). The highest SAA level was detected in the CP group (168.6 µg/ml) and this level is statistically significant compared to the other groups (P= 0.028). While there was no correlation between SAA levels and SIRS criteria, SAA levels were negatively correlated with both AST (P= 0.045, rs=-0.478) and GGT (P= 0.019, rs= -0.548). In the study, it was determined that sepsis and SIRS progressed with different symptoms in cats and SIRS criteria were less specific in cats. It was concluded that SAA levels may be an important marker in closed-cervix pyometra cases. We think that the study data are promising but further and comprehensive studies are needed considering the number of patients included in the study.

Keywords

• Cat
• pyometra
• serum amyloid A
• systemic inflammatory response syndrome

Kaynakça

1. Hollinshead F, & Krekeler N (2016). Pyometra in the queen: to spay or not to spay?. J Feline Med Surg., 18(1): 21-33.
2. Wijewardana V, Sugiura K, Wijesekera DPH, et al. (2015). Effect of ovarian hormones on maturation of dendritic cells from peripheral blood monocytes in dogs. J Vet Med Sci. 77(7): 771-775.
3. Bigliardi E, Parmigiani E, Cavirani S, Luppi A, Bonati L, Corradi A (2004). Ultrasonography and cystic hyperplasia–pyometra complex in the bitch. Reprod Domest Anim. 39(3): 136-140.
4. Pretzer SD (2008). Clinical presentation of canine pyometra and mucometra: a review. Theriogenology. 70(3): 359-363.
5. Nak D, Mısırlıoğlu D, Nak Y, Kuzugüden F, Keskin A (2001). Köpeklerde pyometranın tanısında laboratuar, ultrasonografi ve vaginal sitoloji bulgularının karşılaştırmalı olarak değerlendirilmesi üzerine çalışmalar. J Fac Vet Med. 20: 1-7.
6. Özyurtlu N (2012). Köpeklerde pyometra ve tedavi seçeneklerine kısa bir bakış. Dicle Üniv Vet Fak Derg. (1): 34-36.
7. Shah SA, Sood NK, Wani BM, Rather MA, Beigh AB, Amin U (2017). Haematobiochemical studies in canine pyometra. J Pharmacogn Phytochem. 6(4): 14-17.
8. Nak D (1999). Kedi ve köpeklerde pyometranın fizyopatolojisi, tanısı ve prostaglandinlerle sağaltımı. Yüzüncü Yıl Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 5: 79.

9. Eckersall PD, Bell R (2010). Acute phase proteins: Biomarkers of infection and inflammation in veterinary medicine. Vet J. 185(1): 23-27.
10. Murata H, Shimada N, Yoshioka M (2004). Current research on acute phase proteins in veterinary diagnosis: an overview. Vet J. 168(1): 28-40.
11. Paltrinieri S (2008). The feline acute phase reaction. Vet J. 177(1): 26-35.
12. Dąbrowski R, Kostro K, Szczubiał M (2013). Concentrations of C-reactive protein, serum amyloid A, and haptoglobin in uterine arterial and peripheral blood in bitches with pyometra. Theriogenology. 80(5): 494-497.
13. Fransson B (2003). Systemic inflammarory response in canine pyometra. PhD Thesis. Washington State University, Washington. 161.
14. Eroğlu MS, Kırbaş A (2020). Sistemik İnflamatuar Yanıt Sendromu ve Sepsis. Fırat Üniversitesi Sağlık Bilimleri Veteriner Dergisi. 34(1): 61-67.
15. Yazlık MO, Mutluer İ, Yıldırım M, Kaya U, Çolakoğlu HE, Vural MR (2022). The evaluation of SIRS status with hemato-biochemical indices in bitches affected from pyometra and the Usefulness of these indices as a potential diagnostic tool. Theriogenology. 193: 120-127.
16. Greiner M, Wolf G, Hartmann K (2008). A retrospective study of the clinical presentation of 140 dogs and 39 cats with bacteraemia. J Small Anim Prac. 49(8): 378-383.
17. Thomovsky EJ, Johnson PA, Brooks AC (Eds.). (2020). Basic Monitoring in Canine and Feline Emergency Patients. CABI. Wallingford; Oxfordshire, UK.
18. Gatel L, Gory G, Chalvet-Monfray K, Saunders JH, Rault DN (2016). Intra-and inter-observer variability in ultrasonographical measurements of the uterus and ovaries in healthy, nonpregnant queens. J Feline Med Surg. 18(2): 110-117.
19. Wallace GB, Casal ML (2019). Pyometra. In: Drobatz KJ, Hopper K, Rozanski E, Silverstein DC, eds. Textbook of Small Animal Emergency Medicine. I&II. John Wiley & Sons, Inc, 75–801.
20. Hagman R, Holst BS, Möller L, Egenvall A (2014). Incidence of pyometra in Swedish insured cats. Theriogenology. 82(1): 114-120.
21. Chakraborty RK, Burns B (2019). Systemic inflammatory response syndrome. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2023.
22. Waddell LS, Brady CA, Drobatz KJ (2002). Risk factors, prognostic indicators, and outcome of pyothorax in cats: 80 cases (1986-1999). J Am Vet Med Assoc. 221(6): 819-824.
23. Costello MF, Drobatz KJ, Aronson LR, King LG (2004). Underlying cause, pathophysiologic abnormalities, and response to treatment in cats with septic peritonitis: 51 cases (1990–2001). J Am Vet Med Assoc. 225(6): 897-902.
24. Sergeeff JS, Armstrong PJ, Bunch SE (2004). Hepatic abscesses in cats: 14 cases (1985– 2002). J Vet Intern Med. 18(3): 295-300.
25. Brady CA, Otto CM, Van Winkle TJ, King LG (2000). Severe sepsis in cats: 29 cases (1986– 1998). J Am Vet Med Assoc. 217(4): 531-535.
26. Hauptman JG, Walshaw R, Olivier NB (1997). Evaluation of the sensitivity and specificity of diagnostic criteria for sepsis in dogs. Vet Surg. 26(5): 393-397.
27. Purvis D, Kirby R (1994). Systemic inflammatory response syndrome: septic shock. Vet Clin North Am Small Anim Pract. 24(6): 1225-1248.
28. Lucas AN, Firth AM, Anderson GA, Vine JH, Edwards GA (2001). Comparison of the effects of morphine administered by constant-rate intravenous infusion or intermittent intramuscular injection in dogs. J Am Vet Med Assoc. 218(6): 884-891.
29. McGowan E, Silverstein D (2015). Systemic inflammatory response syndrome and sepsis. Today’s Veterinary Practice. 5: 38-44.
30. DeClue AE, Delgado C, Chang CH, Sharp CR (2011). Clinical and immunologic assessment of sepsis and the systemic inflammatory response syndrome in cats. J Am Vet Med Assoc. 238(7): 890-897.
31. Polderman KH (2009). Mechanisms of action, physiological effects, and complications of hypothermia. Crit Care Med. 37(7): 186-202.
32. Schwartz PJ, Pagani M, Lombardi F, Mallaiani A, Brown AM (1973). A cardiocardiac sympathovagal reflex in the cat. Circ Res. 32(2): 215-220.
33. Nak D, Misirlioglu D, Nak Y, Keskin A (2005). Clinical laboratory findings, vaginal cytology and pathology in a controlled study of pyometra in cats. Aust Vet Pract. 35(1): 10-14.
34. Blanco PG, Rube A, López Merlo M, et al. (2018). Uterine two‐dimensional and Doppler ultrasonographic evaluation of feline pyometra. Reprod Domest Anim. 53: 70-73.
35. Rossi G (2023). Acute phase proteins in cats: Diagnostic and prognostic role, future directions, and analytical challenges. Vet Clin Pathol. 52: 37-49.
36. Børresen B, Skrede S (1980). Pyometra in the dog--a pathophysiological investigation. V. The presence of intrahepatic cholestasis and an" acute phasereaction.". Nordisk veterinärmedicin. 32(9): 378-386.
37. El-Bahr SM, El-Deeb WM (2016). Acute-phase proteins, oxidative stress biomarkers, proinflammatory cytokines, and cardiac troponin in Arabian mares affected with pyometra. Theriogenology. 86(4): 1132-1136.
38. Bazzano M, Marchegiani A, Troisi A, McLean A, Laus F (2022). Serum Amyloid A as a Promising Biomarker in Domestic Animals’ Reproduction: Current Knowledge and Future Perspective. Animals. 12(5): 589.
39. Cerón JJ, Martinez-Subiela S, Ohno K, Caldin M (2008). A seven-point plan for acute phase protein interpretation in companion animals. Vet J. 1(177): 6-7.
40. Vilhena H, Figueiredo M, Cerón JJ, et al. (2018). Acute phase proteins and antioxidant responses in queens with pyometra. Theriogenology. 115: 30-37.
41. Jitpean S, Pettersson A, Höglund OV, Holst BS, Olsson U, Hagman R (2014). Increased concentrations of Serum amyloid A in dogs with sepsis caused by pyometra. BMC Vet Res. 10(1): 1-9.
42. Kann RKC, Seddon JM, Henning J, Meers J (2012). Acute phase proteins in healthy and sick cats. Res Vet Sci. 93(2): 649-654.
43. Yuki M, Aoyama R, Nakagawa M, Hirano T, Naitoh E, Kainuma D (2020). A clinical investigation on serum amyloid A concentration in client-owned healthy and diseased cats in a primary care animal hospital. Vet Sci. 7(2): 45.
44. Bagul R, Chandan S, Sane VD, Patil S, Yadav D (2017). Comparative evaluation of C-reactive protein and WBC count in fascial space infections of odontogenic origin. J Maxillofac Oral Surg. 16: 238-242.
45. Reny JL, Vuagnat A, Ract C, Benoit MO, Safar M, Fagon JY (2002). Diagnosis and follow-up of infections in intensive care patients: value of C-reactive protein compared with other clinical and biological variables. Crit Care Med. 30(3): 529-535.
46. Heiene R, Kristiansen V, Teige J, Jansen JH (2007). Renal histomorphology in dogs with pyometra and control dogs, and long term clinical outcome with respect to signs of kidney disease. Acta Vet Scand. 49: 1-9.
47. Fransson BA, Ragle CA (2003). Canine pyometra: an update on pathogenesis and treatment. Compendium. 25(8): 602-612.
48. Paudel M, Kafle S, Gompo TR, Khatri KB, Aryal A (2023). Microbiological and hematological aspects of canine pyometra and associated risk factors. Heliyon. 9(12).
49. Bush BM (1991). Interpretation of laboratory results for small animal clinicians. Blackwell Scientific, Oxford, UK., 515.
50. Verstegen J, Dhaliwal G, Verstegen-Onclin K (2008). Mucometra, cystic endometrial hyperplasia, and pyometra in the bitch: advances in treatment and assessment of future reproductive success. Theriogenology. 70(3): 364-374.
51. Kozat S, Sepehrizadeh E (2017). Methods of diagnosing in liver diseases for dog and cats. Türk Bilimsel Derlemeler Dergisi. 10(2): 36-46.
52. Brovida C, Rothuizen J (2000). Liver and pancreatic diseases. In Ettinger SJ, Feldman EC, eds, Textbook of veterinary internal medicine. Diseases of the dog and cat. St. Louis. Elsevier Saunders. 1609-1628.