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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)

Kari A. Santoro Beer DVM1, Rebecca S. Syring DVM, DACVECC2, and Kenneth J. Drobatz DVM, MSCE, DACVECC, DACVIM3
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  • 1 Section of Critical Care, Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.
  • | 2 Section of Critical Care, Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.
  • | 3 Section of Critical Care, Department of Clinical Studies, Matthew J. Ryan Veterinary Hospital, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA 19104.

Abstract

Objective—To determine the correlation between plasma lactate concentration and base excess at the time of hospital admission and evaluate each variable as a predictor of gastric necrosis or outcome in dogs with gastric dilatation-volvulus (GDV).

Design—Retrospective case series.

Animals—78 dogs.

Procedures—For each dog, various data, including plasma lactate concentration and base excess at the time of hospital admission, surgical or necropsy findings, and outcome, were collected from medical records.

Results—Gastric necrosis was identified in 12 dogs at the time of surgery and in 4 dogs at necropsy. Sixty-five (83%) dogs survived to hospital discharge, whereas 13 (17%) dogs died or were euthanized. Of the 65 survivors and 8 nonsurvivors that underwent surgery, gastric necrosis was detected in 8 and 4 dogs, respectively. Via receiver operating characteristic curve analysis, an initial plasma lactate concentration cutoff of 7.4 mmol/L was 82% accurate for predicting gastric necrosis (sensitivity, 50%; specificity, 88%) and 88% accurate for predicting outcome (sensitivity, 75%; specificity, 89%). Among all dogs, the correlation between initial plasma lactate concentration and base excess was significant, although base excess was a poor discriminator for predicting gastric necrosis or outcome (area under the receiver operating characteristic curve, 0.571 and 0.565, respectively).

Conclusions and Clinical Relevance—In dogs with GDV, plasma lactate concentration at the time of hospital admission was a good predictor of gastric necrosis and outcome. However, despite the correlation between initial base excess and plasma lactate concentration, base excess should not be used for prediction of gastric necrosis or outcome in those patients.

Abstract

Objective—To determine the correlation between plasma lactate concentration and base excess at the time of hospital admission and evaluate each variable as a predictor of gastric necrosis or outcome in dogs with gastric dilatation-volvulus (GDV).

Design—Retrospective case series.

Animals—78 dogs.

Procedures—For each dog, various data, including plasma lactate concentration and base excess at the time of hospital admission, surgical or necropsy findings, and outcome, were collected from medical records.

Results—Gastric necrosis was identified in 12 dogs at the time of surgery and in 4 dogs at necropsy. Sixty-five (83%) dogs survived to hospital discharge, whereas 13 (17%) dogs died or were euthanized. Of the 65 survivors and 8 nonsurvivors that underwent surgery, gastric necrosis was detected in 8 and 4 dogs, respectively. Via receiver operating characteristic curve analysis, an initial plasma lactate concentration cutoff of 7.4 mmol/L was 82% accurate for predicting gastric necrosis (sensitivity, 50%; specificity, 88%) and 88% accurate for predicting outcome (sensitivity, 75%; specificity, 89%). Among all dogs, the correlation between initial plasma lactate concentration and base excess was significant, although base excess was a poor discriminator for predicting gastric necrosis or outcome (area under the receiver operating characteristic curve, 0.571 and 0.565, respectively).

Conclusions and Clinical Relevance—In dogs with GDV, plasma lactate concentration at the time of hospital admission was a good predictor of gastric necrosis and outcome. However, despite the correlation between initial base excess and plasma lactate concentration, base excess should not be used for prediction of gastric necrosis or outcome in those patients.

Contributor Notes

Dr. Syring's present address is Veterinary Specialty and Emergency Center, 301 Veterans Hwy, Levittown, PA 19056.

Address correspondence to Dr. Beer (ksbeer@vet.upenn.edu).