Retrospective evaluation of the prognostic utility of plasma lactate concentration,base deficit,pH, and anion gap in canine and feline emergency patients |
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| Authors: | Casey J. Kohen DVM DACVECC Kate Hopper BVSc PhD DACVECC Philip H. Kass DVM PhD DACVPM Steven E. Epstein DVM DACVECC |
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| Affiliation: | 1. William R. Pritchard Veterinary Medical Teaching Hospital, School of Veterinary Medicine, University of California at Davis, Davis, CA 95616;2. Departments of Veterinary Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis, Davis, CA 95616;3. Population Health and Reproduction, School of Veterinary Medicine, University of California at Davis, Davis, CA 95616 |
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| Abstract: | Objective To determine the association of plasma lactate concentration, pH, base deficit (BD), and anion gap (AG) in dogs and cats on presentation to an emergency room with outcome, and to compare the prognostic significance of hyperlactatemia with a concurrent metabolic acidosis with that of hyperlactatemia and a normal metabolic acid–base balance. Design Retrospective study. Setting University teaching hospital. Animals Five hundred sixty‐six dogs and 185 cats that had venous blood gas analysis performed. Interventions None. Measurements and Main Results Medical records were reviewed for plasma lactate concentrations, electrolyte concentrations, and acid–base parameters obtained on emergency room admission, clinical diagnosis, and in‐hospital mortality. The primary outcome measure was all‐cause mortality for the hospitalized visit. Median plasma lactate concentration and AG were higher, BD was more negative, and pH was lower, in non‐survivor dogs and cats. The prevalence of hyperlactatemia was 53% in dogs and 30% in cats. Lactic acidosis was present in 42% and 80% of hyperlactatemic dogs and cats, respectively. Multivariate regression analyses revealed that plasma lactate concentration, BD, and pH, but not AG, were independent predictors of mortality in dogs, and that only plasma lactate concentration was an independent predictor of mortality in cats. Mortality was highest for animals with lactic acidosis, at 59.8% in dogs and 49% in cats. Mortality in dogs with lactic acidosis was significantly higher than dogs with hyperlactatemia and a normal acid–base status (P < 0.0001). Conclusions The presence and magnitude of hyperlactatemia on presentation to the emergency room may help identify dogs and cats with high likelihood of in‐hospital mortality, and the presence of lactic acidosis specifically may help identify dogs with yet higher risk of in‐hospital mortality. |
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| Keywords: | acidemia base excess hyperlactatemia lactic acidosis outcome |
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