Prognostic relevance of pre- and postoperative plasma l-lactate measurements in calves with acute abdominal emergencies

Abstract

In both human and veterinary medicine, l-lactate is a well-established prognostic biomarker of disease severity and mortality and has also attracted increasing attention in bovine medicine due to the availability and validation of cheap and portable l-lactate analyzers. The aim of the present study was to evaluate the prognostic accuracy of plasma L-lactate measurements in calves with acute abdominal emergencies before and during the initial therapeutic period after surgical intervention. A prospective observational study was carried out involving 83 hospitalized calves up to an age of 7 mo, which required surgical intervention for reasons of an acute abdominal emergency such as gastrointestinal ileus or peritonitis. Plasma l-lactate (L-LAC) concentrations were determined immediately before initiation of surgery and 6, 12, 24, 48, and 72 h later. The outcome of calves was evaluated 3 mo after discharge by a phone call to the farmer, and a positive outcome was defined if the calf was still alive and the owner was satisfied with the animal's postsurgical progress. A total of 29% of calves were discharged from the hospital and the proportion of calves with a positive outcome after the 3-mo period was 24%. At all sampling times during the first 48 h after initiation of surgical intervention, calves with a negative outcome had significantly higher L-LAC than calves with a positive outcome. A binary logistic regression analysis indicated that the odds for a negative outcome during the 3-mo observation period increased by a factor of 1.23 [95% confidence interval (CI): 1.04-1.44] for every mmol/L increase of L-LAC before initiation of surgical intervention, but by a factor of 5.29 (95% CI: 1.69-16.6) and 5.92 (95% CI: 1.29-27.3) at 12 and 24 h, respectively. The largest area under the receiver operating characteristic curve for L-LAC was observed at 12 h (0.91; 95% CI: 0.83-0.99), and a cut-point of 2.75 mmol/L was identified that had a sensitivity and specificity for predicting a negative outcome of 68 and 100%, respectively. In conclusion, persistent hyper-l-lactatemia during the early postoperative period is a more reliable indicator for a negative outcome in calves with acute surgical abdominal emergencies than hyper-l-lactatemia before initiation of surgical intervention. Postoperative measurements of L-LAC are therefore a clinically useful tool to identify patients with an increased risk for a negative outcome at an early stage after surgical intervention was carried out.

Additive prognostic value of preoperative plasma glucose concentrations in calves undergoing abdominal surgery

“…In this context, recent studies (Lausch et al, 2019(Lausch et al, , 2020Giertzuch et al, 2020) have focused on the prognostic relevance of plasma l-lactate concentrations (l-LAC), because measurement of this metabolite can be easily performed using handheld l-lactate analyzers such as the Lactate-Pro device (Arkray; Buczinski et al, 2014). These studies revealed that markedly increased l-LAC is associated with an increased mortality risk, but that it is not possible to reliably predict the outcome of affected calves based on a single, preoperative measurement (Lausch et al, 2019(Lausch et al, , 2020. However, a remarkable finding was that survival rates of affected neonatal calves are low and the predictive accuracy of l-LAC can be improved when the age of the calf is additionally considered (Lausch et al, 2019).…”

“…A cute abdominal emergencies in calves frequently require surgical intervention and high therapeutic expenditures. These conditions are associated with a grave prognosis, however, as indicated by reported success rates of 24 to 51% (Iselin et al, 1997;Mulon and Desrochers, 2005;Lausch et al, 2020). This issue has been attributed to irreversible organ damage due to rapid disease progression, concomitant complications such as sepsis and endotoxemia, as well as a high prevalence of peritonitis and malformations if neonatal calves are affected (Iselin et al, 1997;Mulon and Desrochers, 2005;Lausch et al, 2019).…”

“…However, a remarkable finding was that survival rates of affected neonatal calves are low and the predictive accuracy of l-LAC can be improved when the age of the calf is additionally considered (Lausch et al, 2019). Furthermore, hyper-l-lactatemia during the initial postoperative period was shown to be a more reliable prognostic indicator than hyper-l-lactatemia before initiation of therapy (Lausch et al, 2020).…”

“…This study is based on analysis of retrospective and prospective data sets [DS1 and DS2, respectively] that were used in previous studies focusing on the prognostic utility of pre-and postoperative l-LAC measurements in calves with surgical abdominal emergencies (Lausch et al, 2019(Lausch et al, , 2020. Because of a partial overlap of investigation periods, a subset of calves up to the age of 21 d in both study populations were part of a much larger data set of 10,060 calves in a previous study on the prevalence, clinical associations, and prognosis of severe hypoglycemia in neonatal calves (Trefz et al, 2016).…”

Acid‐base disorders in sick goats and their association with mortality: A simplified strong ion difference approach

“…5 Hyperlactatemia was diagnosed commonly in sick goats, especially diarrheic goats and those with haemonchosis. Several studies in humans, 38,39 cattle, 12,[40][41][42] horses, 6,43 and dogs 44 have reported hyperlactatemia to be present in the majority of critically ill patients.…”