{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:51:33Z","timestamp":1785919893552,"version":"3.56.0"},"reference-count":35,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Scientific Research Projects Coordination Unit of Sel\u00e7uk University","award":["25212003"],"award-info":[{"award-number":["25212003"]}]},{"award":["25212003"],"award-info":[{"award-number":["25212003"]}],"id":[{"id":"https:\/\/ror.org\/045hgzm75","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Animals"],"abstract":"<jats:p>Trauma-induced shock is a frequent and life-threatening complication in feline patients. Early detection of tissue hypoperfusion is fundamental for improving clinical outcomes; however, due to species-specific physiological responses in cats, conventional markers like the shock index often fail to accurately reflect shock severity. This prospective clinical study aimed to evaluate the prognostic value of the shock index for predicting mortality in traumatized cats and to analyze the relationship between clinical outcome and whole-blood lactate concentrations, the rectal\u2013interdigital temperature gradient (RISG), and the Animal Trauma Triage (ATT) score. Fifty cats presenting with acute trauma were evaluated upon admission and at subsequent time points. Clinical shock was strictly defined by the presence of at least three markers of poor perfusion, including altered mentation, abnormal heart rate, poor peripheral pulses, and hypotension. Data were analyzed using receiver operating characteristic (ROC) curves and multivariable logistic regression. The Shock Index did not significantly distinguish survivors from nonsurvivors at any time point and showed no significant prognostic performance in ROC analysis (p &gt; 0.05). Whole-blood lactate concentration showed modest prognostic discrimination (AUC = 0.678; 95% CI: 0.508\u20130.848; p = 0.041), with an optimal cut-off value of \u22654.46 mmol\/L. However, the wide confidence interval and its lower limit close to 0.5 indicate considerable uncertainty, and this finding should be considered preliminary. The rectal\u2013interdigital temperature gradient showed the highest prognostic performance (AUC = 0.804; 95% CI: 0.677\u20130.931; p &lt; 0.001), with an optimal cut-off value of &lt;2.05 \u00b0C. In multivariable logistic regression, both RISG (OR = 5.016; 95% CI: 1.783\u201314.109; p = 0.002) and whole-blood lactate concentration (OR = 0.567; 95% CI: 0.374\u20130.859; p = 0.007) were independently associated with in-hospital survival. These findings suggest that RISG may provide useful prognostic information, whereas whole-blood lactate concentration may offer complementary but preliminary prognostic information and should be interpreted cautiously. The Shock Index showed limited value for predicting in-hospital outcome in traumatized cats.<\/jats:p>","DOI":"10.3390\/ani16152410","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:14:46Z","timestamp":1785917686000},"page":"2410","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prognostic Performance of Shock Index, Whole-Blood Lactate Concentration, Rectal\u2013Interdigital Temperature Gradient, and ATT Score in Cats with Trauma-Induced Shock"],"prefix":"10.3390","volume":"16","author":[{"given":"Sena","family":"Yaz\u0131c\u0131 \u00d6zcan","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Veterinary Medicine, Selcuk University, Sel\u00e7uklu, 42130 Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8656-037X","authenticated-orcid":false,"given":"Kurtulu\u015f","family":"Parlak","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Veterinary Medicine, Selcuk University, Sel\u00e7uklu, 42130 Konya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1111\/vec.13446","article-title":"Assessment of shock index in healthy cats and in cats presenting to an emergency room with shock","volume":"35","author":"Fadel","year":"2025","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"79","DOI":"10.2460\/javma.247.1.79","article-title":"Association of blood lactate concentration with physical perfusion variables, blood pressure, and outcome for cats treated at an emergency service","volume":"247","author":"Reineke","year":"2015","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2305","DOI":"10.1097\/CCM.0000000000006805","article-title":"Assessment of tissue perfusion pressure in patients with septic shock: Beyond mean arterial pressure","volume":"53","author":"Sanchez","year":"2025","journal-title":"Crit. Care Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1111\/vec.12708","article-title":"Clinical use of plasma lactate concentration. Part 1: Physiology, pathophysiology, and measurement","volume":"28","author":"Rosenstein","year":"2018","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Gaeth, C., Duarte, J., Rodriguez, A., Powers, A., and Stone, R. (2024). II Observational analysis of Point-of-Care Lactate Plus\u2122 Meter in preclinical trauma models. Diagnostics, 14.","DOI":"10.3390\/diagnostics14232641"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1111\/j.1939-1676.2002.tb02343.x","article-title":"Acute stress hyperglycemia in cats is associated with struggling and increased concentrations of lactate and norepinephrine","volume":"16","author":"Rand","year":"2002","journal-title":"J. Vet. Intern. Med."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Troia, R., Buzzurra, F., Ciuffoli, E., Mascalzoni, G., Foglia, A., Magagnoli, I., Dondi, F., and Giunti, M. (2021). Classification of septic shock phenotypes based on the presence of hypotension and hyperlactatemia in cats. Front. Vet. Sci., 8.","DOI":"10.3389\/fvets.2021.692528"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1111\/vec.12090","article-title":"Assessment of shock index in healthy dogs and dogs in hemorrhagic shock","volume":"23","author":"Peterson","year":"2013","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1111\/vec.12640","article-title":"Evaluation of the use of shock index in identifying acute blood loss in healthy blood donor dogs","volume":"27","author":"McGowan","year":"2017","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"874","DOI":"10.2460\/javma.22.11.0521","article-title":"Shock index is positively correlated with acute blood loss and negatively correlated with cardiac output in a canine hemorrhagic shock model","volume":"261","author":"Talbot","year":"2023","journal-title":"J. Am. Vet. Med. Assoc."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1111\/vec.13013","article-title":"Shock index is associated with mortality in canine vehicular trauma patients","volume":"30","author":"Kraenzlin","year":"2020","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1111\/vec.13411","article-title":"Retrospective evaluation of shock index and mortality in dogs with head trauma (2015\u20132020): 86 cases","volume":"34","author":"McConnell","year":"2024","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1111\/j.1476-4431.1994.tb00118.x","article-title":"Development of a scoring system for the veterinary trauma patient","volume":"4","author":"Rockar","year":"1994","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1111\/vec.12885","article-title":"Performance evaluation and validation of the Animal Trauma Triage score and Modified Glasgow Coma Scale in injured cats: A Veterinary Committee on Trauma registry study","volume":"29","author":"Lapsley","year":"2019","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_15","first-page":"e13","article-title":"Prospective evaluation of the Animal Trauma Triage Score and Modified Glasgow Coma Scale in 25 cats with high-rise syndrome","volume":"24","year":"2022","journal-title":"J. Feline Med. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Neimann, A., Weingram, T., and Ko\u017e\u00e1r, M. (2025). Prognostic performance of ATT and mGCS scores in dogs and cats with traumatic injury. Vet. Sci., 12.","DOI":"10.3390\/vetsci12111081"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Phannithi, K., Kasemsuwan, S., Kashemsant, N., and Vijarnsorn, M. (2026). Animal Trauma Triage (ATT) score and clinical determinants of survival in dogs and cats with traumatic injuries in Thailand. Vet. Sci., 13.","DOI":"10.3390\/vetsci13050474"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1111\/vec.12868","article-title":"Utility of admission lactate concentration, lactate variables, and shock index in outcome assessment in dogs diagnosed with shock","volume":"29","author":"Zollo","year":"2019","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1111\/vec.12992","article-title":"Evaluation of the rectal\u2013interdigital temperature gradient as a diagnostic marker of shock in dogs","volume":"30","author":"Schaefer","year":"2020","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"542","DOI":"10.1111\/j.1939-1676.2007.tb03005.x","article-title":"Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats","volume":"21","author":"Brown","year":"2007","journal-title":"J. Vet. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1803","DOI":"10.1111\/jvim.15331","article-title":"ACVIM consensus statement: Guidelines for the identification, evaluation, and management of systemic hypertension in dogs and cats","volume":"32","author":"Acierno","year":"2018","journal-title":"J. Vet. Intern. Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1373","DOI":"10.1016\/S0895-4356(96)00236-3","article-title":"A simulation study of the number of events per variable in logistic regression analysis","volume":"49","author":"Peduzzi","year":"1996","journal-title":"J. Clin. Epidemiol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1093\/aje\/kwk052","article-title":"Relaxing the rule of ten events per variable in logistic and Cox regression","volume":"165","author":"Vittinghoff","year":"2007","journal-title":"Am. J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4161\/viru.26482","article-title":"Pathophysiology of microcirculatory dysfunction and the pathogenesis of septic shock","volume":"5","author":"Donadello","year":"2014","journal-title":"Virulence"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"S8","DOI":"10.1186\/cc14726","article-title":"Hemodynamic coherence and the rationale for monitoring the microcirculation","volume":"19","author":"Ince","year":"2015","journal-title":"Crit. Care"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1001\/jama.2019.0071","article-title":"Effect of a resuscitation strategy targeting peripheral perfusion status vs. serum lactate levels on 28-day mortality among patients with septic shock: The ANDROMEDA-SHOCK randomized clinical trial","volume":"321","author":"Damiani","year":"2019","journal-title":"JAMA"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1111\/vec.12676","article-title":"Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients","volume":"28","author":"Kohen","year":"2018","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Yu, B., Park, C.G., Lee, K., and Jo, Y.Y. (2025). Utility of the shock index as a prognostic predictor in patients undergoing emergency surgery for trauma: A single-center retrospective study. J. Clin. Med., 14.","DOI":"10.3390\/jcm14196783"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Lin, P.-C., Wu, M.-Y., Chien, D.-S., Chung, J.-Y., Liu, C.-Y., Tzeng, I.-S., Hou, Y.-T., Chen, Y.-L., and Yiang, G.-T. (2024). Use of reverse shock index multiplied by simplified motor score in a five-level triage system: Identifying trauma in adult patients at a high risk of mortality. Medicina, 60.","DOI":"10.3390\/medicina60040647"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1111\/vec.12161","article-title":"Measuring level of agreement between values obtained by directly measured blood pressure and ultrasonic Doppler flow detector in cats","volume":"24","author":"Saile","year":"2014","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1111\/vec.12496","article-title":"Hyperlactatemia and serial lactate measurements in sick cats","volume":"26","author":"Redavid","year":"2016","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0895-4356(00)00314-0","article-title":"Adjusting for multiple testing\u2014When and how?","volume":"54","author":"Bender","year":"2001","journal-title":"J. Clin. Epidemiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.jfms.2003.07.001","article-title":"Feline high-rise syndrome: 119 cases (1998\u20132001)","volume":"6","author":"Vnuk","year":"2004","journal-title":"J. Feline Med. Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/vec.13106","article-title":"Retrospective evaluation of the prognostic utility of plasma lactate concentration and serial lactate measurements in dogs and cats presented to the emergency room (January 2012\u2013December 2016): 4863 cases","volume":"32","author":"Hopper","year":"2022","journal-title":"J. Vet. Emerg. Crit. Care"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Chang, W.-H., Hu, T.-Y., and Kuo, L.-K. (2026). Peak lactate within 24 h and mortality in septic shock patients receiving continuous renal replacement therapy: A real-world cohort from an Asian ICU (2018\u20132020). Life, 16.","DOI":"10.3390\/life16010062"}],"container-title":["Animals"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2615\/16\/15\/2410\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:37:34Z","timestamp":1785919054000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2615\/16\/15\/2410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":35,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ani16152410"],"URL":"https:\/\/doi.org\/10.3390\/ani16152410","relation":{},"ISSN":["2076-2615"],"issn-type":[{"value":"2076-2615","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}