Predictive value of plasma and peritoneal creatine kinase in horses with strangulating intestinal lesions

Abstract

Objective: To determine the ability of plasma and peritoneal creatine kinase (CK) to predict the presence of a strangulating lesion in horses presented for colic. Study design: Prospective clinical study. Animals: Ten healthy control horses and 61 clinical colic cases. Methods: Creatine kinase activity was measured in peritoneal fluid and plasma of 10 healthy horses and 61 horses presenting for colic (40 horses with nonstrangulating lesions and 21 horses with strangulating lesions). Information on other blood and peritoneal fluid variables, signalment, results from the physical examination, outcome, requirement for surgery, and lesion location and type were retrieved from the medical records of horses presenting for colic. Results: A peritoneal CK cutoff level of 16 IU/L yielded a sensitivity of 95.2% and a specificity of 84.6% (positive predictive value [PPV] = 76.9% and negative predictive value [NPV] = 97%, respectively) for predicting a strangulating lesion. A peritoneal lactate cutoff level of 3.75 mmol/L yielded a sensitivity of 81% and a specificity of 92% (PPV = 85% and NPV = 90%, respectively) for predicting a strangulating lesion. Conclusion: Peritoneal CK concentration was a sensitive indicator of the presence of a strangulating lesion in horses presenting with colic, whereas peritoneal lactate concentration was a more specific indicator. Clinical significance: Measuring CK in peritoneal fluid may be a useful adjunct to clinical case presentation to accelerate the diagnosis and definitive treatment of horses presenting with strangulating intestinal lesions, thereby improving their outcome.

Prognostic value of colonic and peripheral venous lactate measurements in horses with large colon volvulus

“…With an increasing PCV there is decreased tissue perfusion which decreases oxygen availability for cellular metabolism leading to lactic acidosis from anaerobic respiration. Measurements of lactate concentrations have consequently been associated with outcome in clinical cases of colic and specifically those with intestinal strangulation …”

“…Measurements of lactate concentrations have consequently been associated with outcome in clinical cases of colic and specifically those with intestinal strangulation. 6,[20][21][22][23][24]32 In a retrospective study of peripheral plasma lactate collected preoperatively in horses with ≥360-degree LCV, Johnston et al 6 found that cases with venous plasma lactate concentration < 6 mmol/L at admission had a > 90% chance of survival; in comparison, only 30% of horses survived with a plasma lactate concentration > 7 mmol/ L. In that study, lactate measurements had a positive predictive value of 96%, thereby supporting the use of lactate measurements to predict short-term survival. In similar samples collected in our study, although peripheral venous lactate values measured at admission were statistically associated with death, the PPV was only 32% with a 59% accuracy.…”

“…Peripheral and peritoneal lactate measurements are objective, are rapidly available, and have been associated with outcome in cases of colic . The elevated peripheral lactate values measured in cases of strangulating LCV are predominantly attributed to the ischemic large colon, although systemic hypoperfusion, endotoxic shock, and hypotension contribute to the increased values .…”

“…Peripheral and peritoneal lactate measurements are objective, are rapidly available, and have been associated with outcome in cases of colic. 6,[20][21][22][23][24] The elevated peripheral lactate values measured in cases of strangulating LCV are predominantly attributed to the ischemic large colon, although systemic hypoperfusion, endotoxic shock, and hypotension contribute to the increased values. 6,21,25 Venous plasma lactate concentrations measured in cases of LCV at the time of admission were found to be strongly associated with colonic viability and survival.…”

Highlights of recent clinically relevant papers

“…This prospective study by Isabelle Kilcoyne and colleagues in the USA assessed the ability of plasma and peritoneal creatine kinase (CK) to predict the presence of a strangulating lesion in horses presented for colic .…”