Association of hyperlactatemia with age, diagnosis, and survival in equine neonates

Abstract

Objective – To investigate the association between blood lactate concentration, measured at admission and following 12–36 hours of treatment, and age, diagnosis, and survival in neonatal foals. Design – Retrospective, observational study. Setting – Two equine referral hospitals. Animals – One hundred and twelve foals ≤96 hours of age were included. Interventions – Arterial or venous blood samples were obtained from all foals at admission and surviving foals at 12–36 hours. Measurements – The lactate concentration (LAC) was recorded at 2 time points: admission (LAC‐Admission) and 12–36 hours following treatment (LAC‐24 hours). Main Results – LAC decreased by 0.05 mmol/L for each increased hour of age at presentation. Premature/dysmature foals demonstrated increased odds of nonsurvival of 55% for each 1 mmol/L increase in LAC‐Admission while foals with major diagnoses of neonatal encephalopathy (NE), enteritis and ‘Other’ had increased odds of nonsurvival of 52%, 113%, and 247%, respectively, for each 1.0 mmol/L increase in LAC. Blood‐culture positive foals had significantly lower LAC than blood culture negative foals. LAC‐Admission and LAC‐24 hours were significantly larger in nonsurviving foals. LAC‐Admission of >6.9 mmol/L and LAC‐24 hours >3.2 mmol/L, respectively, correctly classified 85.6% and 94.1% of cases as survivors or nonsurvivors. No differences were found when the 24‐hour change in LAC was investigated in terms of outcome, age at admission, or major diagnosis; however, LAC‐24 hours remained significantly associated with survival. Conclusions – Admission or persistent hyperlactatemia is associated with a nonsurvival. Younger foals, premature/dysmature foals, and foals with neonatal encephalopathy had the largest LAC.

Sequential Plasma Lactate Concentrations as Prognostic Indicators in Adult Equine Emergencies

“…Moreover, in two severe diseases, large intestinal strangulating disease and colitis, both [LAC] and [LAC]Δ T appeared to have the strongest associations with outcome. Blood lactate concentration has long been recognized as a useful indicator of disease severity in human medicine 1–3 and there is increasing interest in its value in veterinary medicine as a resuscitation end‐point and prognostic indicator 4–9 . However, as with any variable, measurement of [LAC] at a single time point can be misleading and admission [LAC] is not always strongly associated with outcome 10–13 .…”

“…Studies in equine neonates have shown that [LAC] remains increased in nonsurvivors 4,5 and a recent retrospective study demonstrated an association between the change in [LAC] over time ([LAC]Δ T ), used as a rough estimate of lactate clearance, and survival 6 . In a recent study of neonatal foals, [LAC]Δ T was lower (ie, [LAC] decreased more slowly) in nonsurvivors when compared with survivors, similar to what has been observed in adult humans 6,17,19 .…”

“…Patients with a delayed return to normolactatemia or persistent hyperlactatemia, have a higher case fatality rate and incidence of multiple organ dysfunction when compared with patients who rapidly attain a normal [LAC] 11–13,17–21 . Studies in equine neonates have consistently shown that [LAC] remains increased in nonsurvivors and, further, that the odds ratio (OR) for poor outcome increases each day that [LAC] remains higher than normal 4–6 . A recent study has demonstrated that the change in [LAC] over time ([LAC]Δ T ; an approximation of lactate clearance) is lower in nonsurviving foals when compared with foals that survive to 4 days after admission or survive to discharge 6 .…”

Effects of intravenous administration of polymyxin B in neonatal foals with experimental endotoxemia

“…Hyperlactatemia has been used as a prognostic guide in ill neonatal foals, with blood lactate concentration significantly higher in nonsurviving foals. [34][35][36] Hyperlactatemia can occur via a multitude of pathophysiologic mechanisms, with the most common mechanism arising from anaerobic tissue metabolism, which occurs with an imbalance between oxygen delivery and tissue demand (type A hyperlactatemia). 37 Hyperlactatemia may also occur under conditions of adequate oxygen delivery (type B hyperlactatemia) in the face of increased or impaired oxygen utilization secondary to the systemic inflammatory response syndrome, sepsis, neoplasia, or mitochondrial dysfunction.…”

Prognostic examinations of neonatal foals with perinatal asphyxia syndrome (PAS)

“…Hypo-oder Hyperglykämie (Hollis et al 2008) und Hyperlaktatämie (Corley et al 2005, Henderson et al 2008, Veronessi et al 2009, Wotman et al 2009) sowie eine gestörte Laktatclearance (Wotman et al 2009) wurden bei erkrankten Fohlen als Indikatoren einer ungünstigen Prognose beschrieben. Eine erhöhte Anionenlücke korrelierte bei Fohlen mit respiratorischen Erkrankungen und bei Fohlen in intensivmedizinischer Therapie mit schlechteren Überlebenschancen (Hoffman et al 1992, Bedenice et al 2003b).…”