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C-reactive protein levels in canine parvovirus | VETgirl Veterinary CE Podcasts

In this VETgirl online veterinary CE podcast, we review C-reactive protein levels and whether or not they can be useful in managing your parvovirus cases.

What kind of prognosis do you give your patients with parvoviral enteritis? What do you base it on?

You might know a little bit about C-reactive protein (CRP), which is an acute phase protein (APP) that is released from the liver when stimulated by pro-inflammatory cytokines. CRP levels are correlated with inflammation and disease progression, and have been investigated in a number of human and veterinary diseases and conditions including severe sepsis, pancreatitis, neoplasia and leptospirosis. In a previous study looking at CRP levels in dogs with parvovirus, CRP concentration at presentation was higher in nonsurvivors than survivors.1

While parvovirus has been recognized in dogs for over 40 years, it can still be difficult to treat, with no specific therapy showing a proven benefit. Mainstays of treatment still include aggressive supportive care and antimicrobial treatment with early enteral nutrition recommended. Without treatment, mortality is high (greater than 90%) in some studies, and even with aggressive treatment we still lose some patients (4-48%).2,3 That said, a more recent study has found a much better prognosis (>80%), even with outpatient therapy.a An accurate prognostic test would be useful to help us predict outcome and give owners more information about moving forward with treatment of their pets.

Based on that goal, McClure et al from University of Pretoria and University of Copenhagen performed a prospective study called “Evaluation of the use of serum C-reactive protein concentration to predict outcome in puppies infected with canine parvovirus.”4 In this study, they looked at CRP concentrations in puppies with parvoviral enteritis over the course of their hospitalization. They included 79 puppies in the study; 80% survived, while 20% (16/79) died. They measured CRP values at presentation, every 10-12 hours for the first 48 hours, and then every 24 hours until discharge or death. Mean CRP concentrations at admission, 12 and 24 hours were significantly higher in non-survivors compared to survivors. Higher CRP concentrations at these time points were associated with increased odds of death. Overall, higher CRP concentrations were also associated with shorter survival times. In this study, duration of hospitalization was associated with CRP concentrations from 12-36 hours. Using ROC curve analysis, CRP concentration was most predictive of survival at 24 hours, with a cutoff of 97.3 mg/L (AUC 0.79; 95% CI 0.68 to 0.97).

In this study, puppies with higher CRP concentrations (2-fold difference) at 12 and 24 hours after admission had shorter survival times compared to puppies with lower CRP concentrations. Of the puppies that survived, those with higher CRP concentrations had longer lengths of hospitalization. The ROC cutoff value was moderately accurate, with a sensitivity of 86.7% and specificity of 78.7% to predict death.

So, what can we take away from this VETgirl podcast?

While C-reactive protein concentrations were associated with outcome in these puppies with parvovirus, they were not very good predictors of outcome. That said, this study did a nice job of evaluating CRP concentrations over the course of hospitalization, although results likely had some inherent variation since they were presented at different times in the courses of their illness. Overall, this study suggests CRP concentrations are associated with outcome, but the predictive value was not very high and the ideal time for measurement (after 24 hours of hospitalization) may not be the most helpful for owners making decisions based on finances. In the future, the use of CRP measurements combined with additional information may become more valuable for our parvovirus puppies.

References:
1. Kocaturk M, Martinez S, Eralp O et al. Prognostic value of serum acute-phase proteins in dogs with parvoviral enteritis. J Small Anim Pract 2010;51:478-483.
2. Kalli I, Leontides LS, Mylonakis ME et al. Factors affecting the occurrence, duration of hospitalization and final outcome in canine parvovirus infection. Res Vet Sci 2010;89:174-178.
3. Prittie J. Canine parvoviral enteritis: a review of diagnosis, management, and prevention. J Vet Emerg Crit Care 2004;14:167-176.
4. McClure V, van Schoor M, Thompson PN, et al. Evaluation of the use of serum c-reactive protein concentration to predict outcome in puppies infected with canine parvovirus. J AmVet Med Assoc 2013;243:361-366.

Footnote:
a Sullivan LA, Twedt DC, Boscan PL. Evaluation of an outpatient protocol in the treatment of canine parvoviral enteritis, J Vet Emerg Crit Care, In press.

Abbreviations:

  • CRP: C-reactive protein

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