Sequential Plasma Lactate Concentrations as Prognostic Indicators in Adult Equine Emergencies

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Abstract
Background: Sequential lactate concentration ([LAC]) measurements have prognostic value in that hospitalized humans and neonatal foals that have a delayed return to normolactatemia have greater morbidity and case fatality rate. Hypothesis: Prognosis for survival is decreased in horses with a delayed return to normal [LAC]. Animals: Two hundred and fifty adult horses presented for emergency evaluation excepting horses evaluated because of only ophthalmologic conditions, superficial wounds, and septic synovitis without systemic involvement. Methods: Prospective observational study. [LAC] was measured at admission and then at 6, 12, 24, 48, and 72 hours after admission. The change in [LAC] over time ([LAC]ΔT) was calculated from changes in [LAC] between sampling points. Results: Median [LAC] was significantly (P < .001) higher at admission in nonsurvivors (4.10 mmol/L [range, 0.60–18.20 mmol/L]) when compared with survivors (1.30 mmol/L [range, 0.30–13.90 mmol/L]) and this difference remained at all subsequent time points. The odds ratio for nonsurvival increased from 1.29 (95% confidence interval 1.17–1.43) at admission to 49.90 (6.47–384) at 72 hours after admission for every 1 mmol/L increase in [LAC]. [LAC]ΔT was initially positive in all horses but became negative and significantly lower in nonsurvivors for the time periods between 24–72 hours (− 0.47, P= .001) and 48–72 hours (− 0.07, P= .032) when compared with survivors (0.00 at both time periods) consistent with lactate accumulation in nonsurvivors. Conclusions and Clinical Importance: These results indicate that lactate metabolism is impaired in critically ill horses and [LAC]ΔT can be a useful prognostic indicator in horses.

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