Feline acute patient physiologic and laboratory evaluation scores and other prognostic factors in cats with first-time diabetic ketoacidosis

Background

Acute Patient Physiologic and Laboratory Evaluation (APPLE) scores have not been reported in cats with diabetic ketoacidosis (DKA).

Hypothesis

In cats with DKA, APPLE scores will be significantly higher in non-survivors compared with survivors and these scores will predict mortality.

Animals

Sixty-eight cats with DKA.

Methods

Retrospective study. The APPLE scores, blood glucose concentration (BG), venous pH, and ketone concentrations were compared between survivors and non-survivors. Simple logistic regression was used to determine if these variables predict the binary variable of survival or non-survival, and if they did, an empirical optimal cut point for mortality prediction was calculated.

Results

The APPLE_fast and APPLE_full scores were significantly higher in non-survivors (30 cats; $24.6\pm 7.4$ and $45.2\pm 7.3$, respectively) compared with survivors (38 cats; $20.9\pm 6.2$ and $41.7\pm 6.5$; P = .01 and P = .02, respectively). The APPLE_fast (P = .03) but not the APPLE_full scores (P = .06) predicted mortality. For every 1 unit increase in the APPLE_fast score, the odds of death increased by 1.08 (95% confidence interval [CI], 1.006-1.17; P = .03). Median BG was significantly higher in non-survivors (431 mg/dL; range, 260-832 mg/dL) compared with survivors (343 mg/dL; range, 256-738 mg/dL; P = .01) and BG predicted mortality (P = .02). For every 1 mg/dL increase in BG, the odds of death increased by 1.004 (95% CI, 1.0006-1.008). Empirical optimal cut points for APPLE_fast and BG mortality prediction were 24.5 and 358 mg/dL, respectively.

Conclusions and Clinical Importance

The APPLE_fast score and BG predict mortality in cats with DKA and can be used to stratify populations by risk of mortality in clinical trials of DKA in cats.