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

• Published in: Journal of dairy science 2020-02, Vol.103 (2), p.1856-1865
• Main Authors: Lausch, C.K., Lorch, A., Giertzuch, S., Rieger, A., Knubben-Schweizer, G., Trefz, F.M.
• Format: Article
• Language: English
• Subjects: Abdomen, Acute - diagnosis; Abdomen, Acute - surgery; Abdomen, Acute - veterinary; Animals; Animals, Newborn; calf; Cattle; Cattle Diseases - diagnosis; Cattle Diseases - surgery; Emergencies - veterinary; Female; hyper-l-lactatemia; Hyperlactatemia - diagnosis; Hyperlactatemia - veterinary; ileus; Ileus - diagnosis; Ileus - surgery; Ileus - veterinary; Lactic Acid - blood; Male; peritonitis; Peritonitis - diagnosis; Peritonitis - surgery; Peritonitis - veterinary; Prognosis; Prospective Studies; Sensitivity and Specificity; surgical abdominal emergency
• ISSN: 0022-0302; 1525-3198
• DOI: 10.3168/jds.2019-17224

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 w