Journal of Veterinary Emergency and Critical Care 28(2) 2018, pp 149–156
Retrospective evaluation of plasma
cholesterol concentration in septic dogs and
its association with morbidity and mortality:
51 cases (2005–2015)
Jack P. Hardy, DVM, DACVECC; Elizabeth M. Streeter, DVM, DACVECC and
Rhonda R. DeCook, PhD
Objective – To determine whether plasma cholesterol concentrations in dogs with sepsis is associated with
morbidity or in-hospital mortality.
Design – Retrospective cohort study from 2005–2015.
Setting – Two private referral centers.
Animals – Fifty-one dogs diagnosed with sepsis.
Interventions – None.
Measurements and Main Results – Dogs were classiﬁed as septic if they displayed ࣙ2 criteria of the systemic
inﬂammatory response syndrome in conjunction with a documented underlying infectious cause. Dogs were
excluded if they had been diagnosed previously with any concurrent illness reported to alter plasma cholesterol
concentrations. Plasma cholesterol concentrations at the time of sepsis diagnosis were statistically analyzed for
association with morbidity, as measured by the presence of organ dysfunction, the number of dysfunctional
organs, duration of hospitalization, cost of hospitalization, and in-hospital mortality.
Twenty-eight (55%) dogs survived to discharge, 15 (29%) were euthanized during hospitalization, and 8 (16%)
died despite treatment. While median cholesterol concentrations were signiﬁcantly different when comparing
survivors to discharge versus nonsurvivors who died naturally despite treatment (P = 0.0245), they were not
signiﬁcantly different when comparing survivors to all nonsurvivors (P = 0.1821). Receiver operating charac-
teristic curve analysis showed a cholesterol cutoff of 4.5 mmol/L (174 mg/dL) with a sensitivity of 75% and
a speciﬁcity of 50% for predicting in-hospital mortality. For surviving dogs, plasma cholesterol concentrations
were not associated with increased length of hospital stay. Number of dysfunctional organs and plasma choles-
terol concentration were the 2 most signiﬁcant individual predictors for survival, and when incorporated into a
multivariate logistic regression model used for prediction, the model yielded a sensitivity of 94% and speciﬁcity
Conclusion – Plasma cholesterol concentration can provide prognostic information in dogs with sepsis. Further
prospective studies investigating the role of cholesterol in sepsis are needed.
(J Vet Emerg Crit Care 2018; 28(2): 149–156) doi: 10.1111/vec.12705
biomarkers, critical care, multiple organ failure, sepsis, small animal
From the Department of Emergency and Critical Care, Eastern Iowa Veteri-
nary Specialty Center, IA Cedar Rapids (Hardy, Streeter); and Department
of Statistics and Actuarial Science (DeCook), The University of Iowa, Iowa
The authors declare no conﬂicts of interest.
Address correspondence and reprint requests to
Dr. Jack Hardy, 5914 Johnson Drive, Mission, KS 66202.
Submitted November 04, 2015; Accepted June 27, 2016.
TNF tumor necrosis factor
WRS Wilcoxon rank-sum
Sepsis is a common cause of morbidity and mortality
in both human and veterinary populations.
lence of sepsis in veterinary medicine has not been
Veterinary Emergency and Critical Care Society 2018