Association of Blood Lactate Concentration and Outcome in Foals |
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| Authors: | K Wotman PA Wilkins JE Palmer RC Boston |
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| Institution: | Department of Clinical Studies, Sections of Large Animal Internal Medicine, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, PA,;Emergency, Critical Care, and Anesthesia, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, PA, and;Bisostatistics, School of Veterinary Medicine, University of Pennsylvania, New Bolton Center, Kennett Square, PA |
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| Abstract: | Background: Lactate concentration in blood or plasma (LAC]) and change in LAC] are associated with survival in sick foals. Hypothesis: LAC] and change in LAC] over time are associated with survival at 96 hours and discharge in neonatal foals. Furthermore LAC] and change in LAC] over time correlate with blood culture results and blood pressure at admission. Animals: Two hundred and twenty‐five foals consecutively admitted to a Neonatal Intensive Care Unit. Methods: Retrospective case review. Foals ≤30 days of age with LAC] from arterial (190) or umbilical (35) blood gas analysis (LAC]BG) at admission, 24, and 48 hours. LAC]BG, blood pressure, blood culture status, and outcome (survival versus nonsurvival at 96 hours and discharge) were recorded. Change in LAC]BG over time (LAC]BGΔT) was calculated. Results: LAC]BG was lower in survivors (96 hours and discharge) at all times. LAC]BGΔT was larger for survivors (96 hours). Odds of survival (96 hours and discharge) decreased 18, 39, 53 and 22, 38, and 47%, respectively, at each sample time for every 1 mmol/L increment in LAC]BG and increased 156% for each 1.0/day increment in LAC]BGΔT from admission to 24 hours at 96 hours. Blood pressure and LAC]BG were not correlated (P= .196) until removal of selected foals (mean arterial pressure <60 mmHg, admission LAC]BG <5.5 mmol/L) (P < .001). Bacteremia was not associated with LAC]BG. Proposed admission LAC]BG cut‐points for future studies were 6.5 mmol/L (96 hours) and 5.5 mmol/L (discharge). Conclusions and Clinical Importance: Prospective studies evaluating LAC], LAC]BGΔT, and cut‐points in sick foals are warranted. |
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| Keywords: | Bacteremia Clearance Critical care Hyperlactatemia Prognosis Sepsis |
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