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Avaliação dos Índices Hematológicos em Piometra Canina
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A piometra canina é uma afeção uterina grave e frequente em cadelas não esterilizadas,
associada a uma resposta inflamatória sistémica marcada e a um risco vital elevado. O
hemograma, exame de rotina simples e económico, permite obter rácios hematológicos
(HRs) que refletem a dinâmica inflamatória e podem apoiar o diagnóstico. O objetivo deste
estudo foi avaliar cinco rácios hematológicos – neutrófilos/linfócitos (NLR),
plaquetas/linfócitos (PLR), monócitos/linfócitos (MLR), volume plaquetário médio/plaquetas
(MPV/PLT) e plaquetas/neutrófilos (PNR) – em cadelas com piometra em comparação com
cadelas saudáveis, e analisar o seu desempenho diagnóstico através de curvas ROC e da
Área Sob a Curva (AUC).
O estudo, de natureza retrospetiva e monocêntrica, incluiu 39 cadelas (20 controlos e 19
com piometra), selecionadas de acordo com critérios rigorosos de inclusão e exclusão. Os
resultados demonstraram que todos os índices diferiram significativamente entre os grupos
(p < 0,05). O NLR e o MLR encontravam-se significativamente aumentados no grupo
piometra, refletindo neutrofilia e monocitose típicas da inflamação sistémica. O MPV/PLT
também se revelou mais elevado, traduzindo ativação plaquetária e maior produção de
plaquetas jovens. Em contrapartida, o PLR e o PNR estavam diminuídos nas cadelas
afetadas, em consequência da combinação entre redução relativa do número de plaquetas e
aumento dos neutrófilos. A análise ROC mostrou que o MPV/PLT apresentou o melhor
desempenho diagnóstico (AUC = 0,866; sensibilidade = 87,5%; especificidade = 90%),
seguido do MLR (AUC = 0,833; sensibilidade = 68,8%; especificidade = 95%) e do NLR
(AUC = 0,761; sensibilidade = 62,5%; especificidade = 85%). O PLR e o PNR, apesar das
diferenças estatísticas, não demonstraram qualquer utilidade clínica (AUC < 0,2).
Em conclusão, alguns rácios simples derivados do hemograma, em particular o MPV/PLT e
o MLR, revelaram-se promissores como biomarcadores complementares no diagnóstico da
piometra canina, enquanto o NLR mantém um poder discriminatório aceitável. Estes
resultados incentivam a sua utilização na prática clínica e sublinham a necessidade de
estudos prospetivos multicêntricos, com amostras mais alargadas e avaliação longitudinal,
de modo a confirmar o seu valor diagnóstico e potencial prognóstico.
Canine pyometra is a severe and frequent uterine disease in intact bitches, associated with a marked systemic inflammatory response and high risk of mortality. The complete blood count (CBC), a simple and relatively inexpensive routine test, provides hematological ratios (HRs) that may reflect inflammatory dynamics and support diagnosis. The aim of this study was to evaluate five hematological ratios—neutrophil-to-lymphocyte ratio (NLR), platelet-to lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), mean platelet volume-to platelet ratio (MPV/PLT), and platelet-to-neutrophil ratio (PNR)—in bitches with pyometra compared with healthy controls, and to assess their diagnostic performance using ROC curve analysis and the Area Under the Curve (AUC). This retrospective, single-center study included 39 bitches (20 controls and 19 with pyometra), selected according to strict inclusion and exclusion criteria. Results showed that all indices differed significantly between groups (p < 0.05). NLR and MLR were significantly increased in the pyometra group, reflecting neutrophilia and monocytosis typical of systemic inflammation. MPV/PLT was also higher, indicating platelet activation and increased release of young platelets. Conversely, PLR and PNR were decreased in affected animals, due to the combination of reduced platelet counts and elevated neutrophils. ROC analysis revealed that MPV/PLT had the best diagnostic performance (AUC = 0.866; sensitivity = 87.5%; specificity = 90%), followed by MLR (AUC = 0.833; sensitivity = 68,8%; specificity = 95%) and NLR (AUC = 0.761; sensitivity = 62,5%; specificity = 85%). PLR and PNR, despite showing statistical differences, demonstrated no clinical utility (AUC < 0.2). In conclusion, some simple ratios derived from the CBC, particularly MPV/PLT and MLR, appear to be promising complementary biomarkers for the diagnosis of canine pyometra, while NLR retains a acceptable discriminative power. These findings encourage their use in clinical practice and highlight the need for prospective multicenter studies with larger cohorts and longitudinal follow-up to confirm their diagnostic and potential prognostic value.
Canine pyometra is a severe and frequent uterine disease in intact bitches, associated with a marked systemic inflammatory response and high risk of mortality. The complete blood count (CBC), a simple and relatively inexpensive routine test, provides hematological ratios (HRs) that may reflect inflammatory dynamics and support diagnosis. The aim of this study was to evaluate five hematological ratios—neutrophil-to-lymphocyte ratio (NLR), platelet-to lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), mean platelet volume-to platelet ratio (MPV/PLT), and platelet-to-neutrophil ratio (PNR)—in bitches with pyometra compared with healthy controls, and to assess their diagnostic performance using ROC curve analysis and the Area Under the Curve (AUC). This retrospective, single-center study included 39 bitches (20 controls and 19 with pyometra), selected according to strict inclusion and exclusion criteria. Results showed that all indices differed significantly between groups (p < 0.05). NLR and MLR were significantly increased in the pyometra group, reflecting neutrophilia and monocytosis typical of systemic inflammation. MPV/PLT was also higher, indicating platelet activation and increased release of young platelets. Conversely, PLR and PNR were decreased in affected animals, due to the combination of reduced platelet counts and elevated neutrophils. ROC analysis revealed that MPV/PLT had the best diagnostic performance (AUC = 0.866; sensitivity = 87.5%; specificity = 90%), followed by MLR (AUC = 0.833; sensitivity = 68,8%; specificity = 95%) and NLR (AUC = 0.761; sensitivity = 62,5%; specificity = 85%). PLR and PNR, despite showing statistical differences, demonstrated no clinical utility (AUC < 0.2). In conclusion, some simple ratios derived from the CBC, particularly MPV/PLT and MLR, appear to be promising complementary biomarkers for the diagnosis of canine pyometra, while NLR retains a acceptable discriminative power. These findings encourage their use in clinical practice and highlight the need for prospective multicenter studies with larger cohorts and longitudinal follow-up to confirm their diagnostic and potential prognostic value.
Descrição
Palavras-chave
Biomarcadores Curvas ROC Diagnóstico veterinário Hemograma Índices hematológicos Inflamação sistémica Piometra canina Biomarkers Canine pyometra Complete blood count Hematological ratios ROC curves Systemic inflammation Veterinary diagnosis