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

摘要

In both human and veterinary medicine, l-lactateis a well-established prognostic biomarker of diseaseseverity and mortality and has also attracted increasingattention in bovine medicine due to the availabilityand validation of cheap and portable l-lactate analyzers.The aim of the present study was to evaluate theprognostic accuracy of plasma L-lactate measurementsin calves with acute abdominal emergencies before andduring the initial therapeutic period after surgical intervention.A prospective observational study was carriedout involving 83 hospitalized calves up to an age of 7mo, which required surgical intervention for reasons ofan acute abdominal emergency such as gastrointestinalileus or peritonitis. Plasma l-lactate (L-LAC) concentrationswere determined immediately before initiationof surgery and 6, 12, 24, 48, and 72 h later. The outcomeof calves was evaluated 3 mo after discharge bya phone call to the farmer, and a positive outcome wasdefined if the calf was still alive and the owner was satisfiedwith the animal’s postsurgical progress. A totalof 29% of calves were discharged from the hospital andthe proportion of calves with a positive outcome afterthe 3-mo period was 24%. At all sampling times duringthe first 48 h after initiation of surgical intervention,calves with a negative outcome had significantly higherL-LAC than calves with a positive outcome. A binarylogistic regression analysis indicated that the oddsfor a negative outcome during the 3-mo observationperiod increased by a factor of 1.23 [95% confidenceinterval (CI): 1.04–1.44] for every mmol/L increase ofL-LAC before initiation of surgical intervention, but bya 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 areaunder the receiver operating characteristic curve for LLACwas observed at 12 h (0.91; 95% CI: 0.83–0.99),and a cut-point of 2.75 mmol/L was identified that hada sensitivity and specificity for predicting a negativeoutcome of 68 and 100%, respectively. In conclusion,persistent hyper-l-lactatemia during the early postoperativeperiod is a more reliable indicator for a negativeoutcome in calves with acute surgical abdominalemergencies than hyper-l-lactatemia before initiationof surgical intervention. Postoperative measurements ofL-LAC are therefore a clinically useful tool to identifypatients with an increased risk for a negative outcomeat an early stage after surgical intervention was carriedout.