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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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.

Original languageEnglish (US)
JournalJournal of Veterinary Emergency and Critical Care
DOIs
StateAccepted/In press - Jan 1 2017

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Acid-Base Equilibrium
Felidae
anions
lactates
Canidae
Lactic Acid
Emergencies
Dogs
cats
Cats
dogs
acidosis
Lactic Acidosis
Hospital Mortality
Mortality
Hospital Emergency Service
milk
Blood Gas Analysis
Acids
acid-base balance

Keywords

  • Acidemia
  • Base excess
  • Hyperlactatemia
  • Lactic acidosis
  • Outcome

ASJC Scopus subject areas

  • veterinary(all)

Cite this

@article{5967ae60f53348d5a07d06c8bcf808b0,
title = "Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients",
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.",
keywords = "Acidemia, Base excess, Hyperlactatemia, Lactic acidosis, Outcome",
author = "Kohen, {Casey J.} and Katrina Hopper and Kass, {Philip H} and Epstein, {Steven E}",
year = "2017",
month = "1",
day = "1",
doi = "10.1111/vec.12676",
language = "English (US)",
journal = "Journal of Veterinary Emergency and Critical Care",
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TY - JOUR

T1 - Retrospective evaluation of the prognostic utility of plasma lactate concentration, base deficit, pH, and anion gap in canine and feline emergency patients

AU - Kohen, Casey J.

AU - Hopper, Katrina

AU - Kass, Philip H

AU - Epstein, Steven E

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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.

AB - 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.

KW - Acidemia

KW - Base excess

KW - Hyperlactatemia

KW - Lactic acidosis

KW - Outcome

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U2 - 10.1111/vec.12676

DO - 10.1111/vec.12676

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JF - Journal of Veterinary Emergency and Critical Care

SN - 1479-3261

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