Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study

A. Borchers; P. A. Wilkins; P. M. Marsh; J. E. Axon; J. Read; C. Castagnetti; L. Pantaleon; C. Clark; L. Qura'n; R. Belgrave; C. Schwarzwald; M. Levy; D. Bedenice; M. N. Saulez; R. C. Boston

doi:10.1111/evj.12165

Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study

A. Borchers, P. A. Wilkins, P. M. Marsh, J. E. Axon, J. Read, C. Castagnetti, L. Pantaleon, C. Clark, L. Qura'n, R. Belgrave, C. Schwarzwald, M. Levy, D. Bedenice, M. N. Saulez, R. C. Boston

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Abstract

Summary: Reasons for performing study: Evaluation of serial blood lactate concentrations [LAC] are of prognostic value for morbidity and mortality in critically ill human patients and neonatal foals, but have not been prospectively evaluated in a large multicentre study of critically ill neonatal foals. Objectives: To prospectively evaluate the prognostic value of sequential [LAC] analysis in critically ill neonatal foals with risk of mortality. Study design: Prospective, observational study. Methods: Thirteen university and private equine referral hospitals enrolled 643 foals over the 2008 foaling season and [LAC] was measured at admission ([LAC]_ADMIT) and 24 ([LAC]₂₄), 48 ([LAC]₄₈), 72 ([LAC]₇₂), 96 ([LAC]₉₆) and 120h ([LAC]₁₂₀) after admission. [LAC] changes over time ([LAC]Δ) were calculated between sampling points. Results: Nonsurvivors had significantly greater [LAC]_ADMIT, [LAC]₂₄ and [LAC]₄₈ compared with surviving foals (P<0.001). In nonsurviving foals [LAC]Δ did not decrease over time while survivors showed significant positive [LAC]Δ between [LAC]_ADM-24 and all other time periods (P<0.001). Logistic regression analysis showed that the odds of survival decreased for each 1mmol/l [LAC] increase at all time points for all critically ill foals, independent of major final diagnoses as potential confounders. Septic foals had significantly greater [LAC] at all time points compared with nonseptic foals (P<0.001) and [LAC]Δ in septic foals was significantly more positive (suggesting better clearance of lactate from the blood) only at [LAC]_ADM-24 and [LAC]_72-96 (P<0.01), while in nonseptic foals [LAC]Δ was significantly positive between [LAC]_ADM-24 compared with all other time periods (P<0.001). Conclusions: Blood lactate concentration is a strong, independent biomarker used to predict mortality in critically ill foals. Lactate metabolism is impaired in nonsurviving and septic foals and [LAC]Δ can be utilised to identify patients at high risk for mortality.

Original language	English (US)
Pages (from-to)	2-7
Number of pages	6
Journal	Equine veterinary journal
Volume	45
Issue number	S45
DOIs	https://doi.org/10.1111/evj.12165
State	Published - Dec 2013

Keywords

Horse
Metabolism
Monitoring
Mortality
Sepsis

ASJC Scopus subject areas

Equine

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10.1111/evj.12165

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Borchers, A., Wilkins, P. A., Marsh, P. M., Axon, J. E., Read, J., Castagnetti, C., Pantaleon, L., Clark, C., Qura'n, L., Belgrave, R., Schwarzwald, C., Levy, M., Bedenice, D., Saulez, M. N., & Boston, R. C. (2013). Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study. Equine veterinary journal, 45(S45), 2-7. https://doi.org/10.1111/evj.12165

Borchers, A, Wilkins, PA, Marsh, PM, Axon, JE, Read, J, Castagnetti, C, Pantaleon, L, Clark, C, Qura'n, L, Belgrave, R, Schwarzwald, C, Levy, M, Bedenice, D, Saulez, MN & Boston, RC 2013, 'Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study', Equine veterinary journal, vol. 45, no. S45, pp. 2-7. https://doi.org/10.1111/evj.12165

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title = "Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study",

abstract = "Summary: Reasons for performing study: Evaluation of serial blood lactate concentrations [LAC] are of prognostic value for morbidity and mortality in critically ill human patients and neonatal foals, but have not been prospectively evaluated in a large multicentre study of critically ill neonatal foals. Objectives: To prospectively evaluate the prognostic value of sequential [LAC] analysis in critically ill neonatal foals with risk of mortality. Study design: Prospective, observational study. Methods: Thirteen university and private equine referral hospitals enrolled 643 foals over the 2008 foaling season and [LAC] was measured at admission ([LAC]ADMIT) and 24 ([LAC]24), 48 ([LAC]48), 72 ([LAC]72), 96 ([LAC]96) and 120h ([LAC]120) after admission. [LAC] changes over time ([LAC]Δ) were calculated between sampling points. Results: Nonsurvivors had significantly greater [LAC]ADMIT, [LAC]24 and [LAC]48 compared with surviving foals (P<0.001). In nonsurviving foals [LAC]Δ did not decrease over time while survivors showed significant positive [LAC]Δ between [LAC]ADM-24 and all other time periods (P<0.001). Logistic regression analysis showed that the odds of survival decreased for each 1mmol/l [LAC] increase at all time points for all critically ill foals, independent of major final diagnoses as potential confounders. Septic foals had significantly greater [LAC] at all time points compared with nonseptic foals (P<0.001) and [LAC]Δ in septic foals was significantly more positive (suggesting better clearance of lactate from the blood) only at [LAC]ADM-24 and [LAC]72-96 (P<0.01), while in nonseptic foals [LAC]Δ was significantly positive between [LAC]ADM-24 compared with all other time periods (P<0.001). Conclusions: Blood lactate concentration is a strong, independent biomarker used to predict mortality in critically ill foals. Lactate metabolism is impaired in nonsurviving and septic foals and [LAC]Δ can be utilised to identify patients at high risk for mortality.",

keywords = "Horse, Metabolism, Monitoring, Mortality, Sepsis",

author = "A. Borchers and Wilkins, {P. A.} and Marsh, {P. M.} and Axon, {J. E.} and J. Read and C. Castagnetti and L. Pantaleon and C. Clark and L. Qura'n and R. Belgrave and C. Schwarzwald and M. Levy and D. Bedenice and Saulez, {M. N.} and Boston, {R. C.}",

year = "2013",

month = dec,

doi = "10.1111/evj.12165",

language = "English (US)",

volume = "45",

pages = "2--7",

journal = "Equine veterinary journal",

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publisher = "Equine Veterinary Journal Ltd.",

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TY - JOUR

T1 - Sequential L-lactate concentration in hospitalised equine neonates

T2 - A prospective multicentre study

AU - Borchers, A.

AU - Wilkins, P. A.

AU - Marsh, P. M.

AU - Axon, J. E.

AU - Read, J.

AU - Castagnetti, C.

AU - Pantaleon, L.

AU - Clark, C.

AU - Qura'n, L.

AU - Belgrave, R.

AU - Schwarzwald, C.

AU - Levy, M.

AU - Bedenice, D.

AU - Saulez, M. N.

AU - Boston, R. C.

PY - 2013/12

Y1 - 2013/12

N2 - Summary: Reasons for performing study: Evaluation of serial blood lactate concentrations [LAC] are of prognostic value for morbidity and mortality in critically ill human patients and neonatal foals, but have not been prospectively evaluated in a large multicentre study of critically ill neonatal foals. Objectives: To prospectively evaluate the prognostic value of sequential [LAC] analysis in critically ill neonatal foals with risk of mortality. Study design: Prospective, observational study. Methods: Thirteen university and private equine referral hospitals enrolled 643 foals over the 2008 foaling season and [LAC] was measured at admission ([LAC]ADMIT) and 24 ([LAC]24), 48 ([LAC]48), 72 ([LAC]72), 96 ([LAC]96) and 120h ([LAC]120) after admission. [LAC] changes over time ([LAC]Δ) were calculated between sampling points. Results: Nonsurvivors had significantly greater [LAC]ADMIT, [LAC]24 and [LAC]48 compared with surviving foals (P<0.001). In nonsurviving foals [LAC]Δ did not decrease over time while survivors showed significant positive [LAC]Δ between [LAC]ADM-24 and all other time periods (P<0.001). Logistic regression analysis showed that the odds of survival decreased for each 1mmol/l [LAC] increase at all time points for all critically ill foals, independent of major final diagnoses as potential confounders. Septic foals had significantly greater [LAC] at all time points compared with nonseptic foals (P<0.001) and [LAC]Δ in septic foals was significantly more positive (suggesting better clearance of lactate from the blood) only at [LAC]ADM-24 and [LAC]72-96 (P<0.01), while in nonseptic foals [LAC]Δ was significantly positive between [LAC]ADM-24 compared with all other time periods (P<0.001). Conclusions: Blood lactate concentration is a strong, independent biomarker used to predict mortality in critically ill foals. Lactate metabolism is impaired in nonsurviving and septic foals and [LAC]Δ can be utilised to identify patients at high risk for mortality.

AB - Summary: Reasons for performing study: Evaluation of serial blood lactate concentrations [LAC] are of prognostic value for morbidity and mortality in critically ill human patients and neonatal foals, but have not been prospectively evaluated in a large multicentre study of critically ill neonatal foals. Objectives: To prospectively evaluate the prognostic value of sequential [LAC] analysis in critically ill neonatal foals with risk of mortality. Study design: Prospective, observational study. Methods: Thirteen university and private equine referral hospitals enrolled 643 foals over the 2008 foaling season and [LAC] was measured at admission ([LAC]ADMIT) and 24 ([LAC]24), 48 ([LAC]48), 72 ([LAC]72), 96 ([LAC]96) and 120h ([LAC]120) after admission. [LAC] changes over time ([LAC]Δ) were calculated between sampling points. Results: Nonsurvivors had significantly greater [LAC]ADMIT, [LAC]24 and [LAC]48 compared with surviving foals (P<0.001). In nonsurviving foals [LAC]Δ did not decrease over time while survivors showed significant positive [LAC]Δ between [LAC]ADM-24 and all other time periods (P<0.001). Logistic regression analysis showed that the odds of survival decreased for each 1mmol/l [LAC] increase at all time points for all critically ill foals, independent of major final diagnoses as potential confounders. Septic foals had significantly greater [LAC] at all time points compared with nonseptic foals (P<0.001) and [LAC]Δ in septic foals was significantly more positive (suggesting better clearance of lactate from the blood) only at [LAC]ADM-24 and [LAC]72-96 (P<0.01), while in nonseptic foals [LAC]Δ was significantly positive between [LAC]ADM-24 compared with all other time periods (P<0.001). Conclusions: Blood lactate concentration is a strong, independent biomarker used to predict mortality in critically ill foals. Lactate metabolism is impaired in nonsurviving and septic foals and [LAC]Δ can be utilised to identify patients at high risk for mortality.

KW - Horse

KW - Metabolism

KW - Monitoring

KW - Mortality

KW - Sepsis

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Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study

Abstract

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