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Sequential L-lactate concentration in hospitalised equine neonates: A prospective multicentre study
A Borchers1, P A Wilkins, P M Marsh
1University of Pennsylvania, USA; University of California, USA.
Equine Veterinary Journal. Supplement
|December 6, 2013
Summary
Serial blood lactate measurements effectively predict mortality in critically ill foals. Higher lactate levels and slower lactate clearance indicate a poorer prognosis, aiding in risk assessment for neonatal foal sepsis.
Area of Science:
- Veterinary Medicine
- Neonatal Critical Care
- Biomarker Research
Background:
- Serial blood lactate concentrations (LAC) are established prognostic indicators for critically ill human patients and neonatal foals.
- A large-scale, prospective, multicenter evaluation of LAC in critically ill neonatal foals was lacking.
- This study addresses the need for robust data on the prognostic value of sequential LAC measurements in this population.
Purpose of the Study:
- To prospectively assess the prognostic significance of sequential blood lactate analysis in critically ill neonatal foals.
- To determine the association between lactate levels, lactate changes over time, and mortality risk in neonatal foals.
- To identify lactate as an independent predictor of mortality, irrespective of underlying diagnoses.
Main Methods:
- A prospective, observational study conducted across thirteen equine referral hospitals.
- Enrolled 643 critically ill neonatal foals during the 2008 foaling season.
- Measured blood lactate concentrations (LAC) at admission (LACADMIT) and at 24, 48, 72, 96, and 120 hours post-admission. Calculated lactate changes over time (LACΔ).
Main Results:
- Nonsurviving foals exhibited significantly higher LACADMIT, LAC24, and LAC48 compared to survivors (P<0.001).
- Survivors demonstrated significant positive LACΔ (lactate clearance) over time, while nonsurvivors showed no decrease.
- Logistic regression confirmed that each 1 mmol/L increase in LAC at any time point independently decreased survival odds. Septic foals had higher lactate levels and impaired lactate clearance compared to nonseptic foals.
Conclusions:
- Blood lactate concentration serves as a potent and independent biomarker for predicting mortality in critically ill foals.
- Impaired lactate metabolism, indicated by elevated LAC and poor LACΔ, is characteristic of nonsurviving and septic foals.
- Sequential LAC monitoring and LACΔ calculations are valuable tools for identifying foals at high risk of mortality.
