DOI
https://doi.org/10.18849/ve.v7i4.537Abstract
PICO question
In dogs presenting with gastric dilatation volvulus, is an admission or pre-operative lactate level a reliable predictor of survival to discharge?
Clinical bottom line
Category of research question
Prognosis
The number and type of study designs reviewed
15 studies (12 retrospective and 3 prospective) were critically appraised
Strength of evidence
Moderate
Outcomes reported
At a population level, lower blood lactate concentration, or lactate concentration that decreases following fluid resuscitation, are associated with a better prognosis.
At a population level, higher blood lactate concentration, or lactate concentration that fails to decrease following fluid resuscitation, is associated with a worse prognosis. However, the lower sensitivity across studies means that a high lactate, or one that does not decrease following fluid therapy, should be interpreted more cautiously than a low lactate; i.e., low lactate predicts survival better than high lactate predicts non-survival.
In all studies, there was a significant overlap in individual blood lactate concentration between survivors and non-survivors
Conclusion
Blood lactate level should only be used to help guide broad, cautiously worded conversations with owners as described above. It should not be used to give a prognosis for individual patients. The overlap between survivors and non-survivors, and the high overall survival rate, means that exploratory laparotomy should be advised irrespective of the blood lactate level
How to apply this evidence in practice
The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.
Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.
References
Blutinger, A., Zollo, A-M., Weltman, J. & Prittie, J. (2021). Prospective evaluation of plasma lactate parameters for prognosticating dogs with shock. Journal of Veterinary Emergency and Critical Care. 31(3), 351–359. DOI: https://doi.org/10.1111/vec.13046
de Papp, E., Drobatz, K.J. & Hughes, D. (1999). Plasma lactate concentration as a predictor of gastric necrosis and survival among dogs with gastric dilatation-volvulus: 102 cases (1995–1998). Journal of American Veterinary Medical Association. 215(1), 49–52.
Grassato, L., Spinella, G., Musella, V., Giunti, M., Vilar, J.M. & Valentini, S. (2020). Pre- and post-surgical evaluation of plasma lactate concentration in 45 dogs with gastric dilatation-volvulus: A preliminary study. Heliyon. 6(1) e03307. DOI: https://doi.org/10.1016/j.heliyon.2020.e03307
Green, J.L., Cimino Brown, D. & Agnello, K.A. (2012). Preoperative thoracic radiographic findings in dogs presenting for gastric dilatation-volvulus (2000–2010): 101 cases. Journal of Veterinary Emergency and Critical Care. 22(5), 595–600. DOI: https://doi.org/10.1111/j.1476-4431.2012.00802.x
Green, T.I., Tonozzi, C.C., Kirby, R. & Rudloff, E. (2011). Evaluation of initial plasma lactate values as a predictor of gastric necrosis and initial and subsequent plasma lactate values as a predictor of survival in dogs with gastric dilatation-volvulus: 84 dogs (2003–2007). Journal of Veterinary Emergency and Critical Care. 21(1), 36–44. DOI: https://doi.org/10.1111/j.1476-4431.2010.00599.x
Israeli, I., Steiner, J., Segev, G., Kass, P.H., Suchodolski, J.S., Sattasathuchana, P., Bruchim, Y., Yudelevitch, S. & Aroch, I. (2012). Serum Pepsinogen-A, Canine Pancreatic Lipase Immunoreactivity, and C-Reactive Protein as Prognostic Markers in Dogs with Gastric Dilatation-Volvulus. Journal of Veterinary Internal Medicine. 26(4), 920–928. DOI: https://doi.org/10.1111/j.1939-1676.2012.00940.x
Kohen, C.J., Hopper, K., Kass, P.H. & Epstein, S.E. (2018). Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients. Journal of Veterinary Emergency and Critical Care. 28(1), 54–61. DOI: https://doi.org/10.1111/vec.12676
Mooney, E., Raw, C. & Hughes, D. (2014). Plasma lactate concentration as a prognostic biomarker in dogs with gastric dilation and volvulus. Topics in Companion Animal Medicine. 29: 71–76. DOI: https://doi.org/10.1053/j.tcam.2014.09.005
O'Neill, D.G., Case, J., Boag, A.K., Church, D.B., McGreevy, P.D., Thomson, P.C. & Brodbelt, D.C. (2017). Gastric dilation-volvulus in dogs attending UK emergency-care veterinary practices: prevalence, risk factors and survival. Journal of Small Animal Practice. 58(11), 629–638. DOI: https://doi.org/10.1111/jsap.12723
Oron, L.D., Klainbart, S., Bruchim, Y., McMurray, J., Boysen, S., Saar, M. & Kelmer, E. (2018). Comparison of saphenous and cephalic blood lactate concentrations in dogs with gastric dilatation and volvulus: 45 cases. Canadian Journal of Veterinary Research. 82(4), 271–277.
Ortolani, J.M. & Bellis, T.J. (2021). Evaluation of the quick sequential organ failure assessment score plus lactate in critically ill dogs. Journal of Small Animal Practice. 62(10), 874–880. DOI: https://doi.org/10.1111/jsap.13381
Rauserova-Lexmaulova, L., Vanova-Uhrikova, I. & Rehakova, K. (2020). Acid-Base, Electrolyte and Lactate Abnormalities as Well as Gastric Necrosis and Survival in Dogs With Gastric Dilation-Volvulus Syndrome. A Retrospective Study in 75 Dogs. Topics in Companion Animal Medicine. 39. DOI: https://doi.org/10.1016/j.tcam.2020.100403
Santoro Beer, K.A., Syring, R.S. & Drobatz, K.J. (2013). Evaluation of plasma lactate concentration and base excess at the time of hospital admission as predictors of gastric necrosis and outcome and correlation between those variables in dogs with gastric dilatation-volvulus: 78 cases (2004–2009). Journal of the American Veterinary Medical Association. 242(1), 54–58. DOI: https://doi.org/10.2460/javma.242.1.54
Sharp, C.R., Rozanski, E.A., Finn, E. & Borrego, E.J. (2020). The pattern of mortality in dogs with gastric dilatation and volvulus. Journal of Veterinary Emergency and Critical Care. 30(2), 232–238. DOI: https://doi.org/10.1111/vec.12932
Spinella, G., Dondi, F., Grassato, L., Magna, L., Cola, V., Giunti, M., Del Magno, S. & Valentini, S. (2018). Prognostic value of canine pancreatic lipase immunoreactivity and lipase activity in dogs with gastric dilatation-volvulus. PLoS One. 13(9). DOI: https://doi.org/10.1371/journal.pone.0204216
Stevenson, C.K., Kidney, B.A., Duke, T., Snead, E.C.R., Mainar-Jaime, R.C. & Jackson, M.L. (2007). Serial blood lactate concentrations in systemically ill dogs. Veterinary Clinical Pathology. 36(3), 234–239. DOI: https://doi.org/10.1111/j.1939-165X.2007.tb00217.x
Troia, R., Massimo, G., Calipa, S. & Goggs, R. (2018). Cell-Free DNA, High-Mobility Group Box-1, and Procalcitonin Concentrations in Dogs With Gastric Dilatation-Volvulus Syndrome. Frontiers Veterinary Science. 5, 67. DOI: https://doi.org/10.3389/fvets.2018.00067
Verschoof, J., Moritz, A., Kramer, M. & Bauer, N. (2017). Hemostatic variables, plasma lactate concentration, and inflammatory biomarkers in dogs with gastric dilatation-volvulus. Tierarztl Prax Ausg K Kleintiere Heimtiere. 43(6), 389–398. DOI: https://doi.org/10.15654/tpk-150284
White, R., Sartor, A. & Bergman, P. (2021). Evaluation of a staged technique of immediate decompressive and delayed surgical treatment for gastric dilatation-volvulus in dogs. Journal of the American Veterinary Medical Association. 258, 72–79. DOI: https://doi.org/10.2460/javma.258.1.72
Zacher, L.A., Berg, J., Shaw, S.P. & Kudej, R.K. (2010). Association between outcome and changes in plasma lactate concentration during presurgical treatment in dogs with gastric dilatation-volvulus: 64 cases (2002–2008). Journal of the American Veterinary Medical Association. 236(8), 892–897. DOI: https://doi.org/10.2460/javma.236.8.892
License
Copyright (c) 2022 David Mackenzie
This work is licensed under a Creative Commons Attribution 4.0 International License.
Veterinary Evidence uses the Creative Commons copyright Creative Commons Attribution 4.0 International License. That means users are free to copy and redistribute the material in any medium or format. Remix, transform, and build upon the material for any purpose, even commercially - with the appropriate citation.
Similar Articles
- Madeleine Thomson, Does occurrence of ventricular arrhythmia reduce the survival rate in dogs with gastric dilatation volvulus (GDV)? , Veterinary Evidence: Vol. 6 No. 4 (2021): The fourth issue of 2021
You may also start an advanced similarity search for this article.
