Prognostic value of colonic and peripheral venous lactate measurements in horses with large colon volvulus.
Authors: Orr Kindra E, Baker W True, Lynch Tim M, Hughes Faith E, Clark Carol K, Slone Donnie E, Fogle Callie A, Gonzalez Liara M
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Prognostic Indicators in Large Colon Volvulus Surgery Large colon volvulus remains a challenging surgical emergency, and identifying horses with the poorest prognosis is crucial for informed clinical decision-making. This prospective study of 40 horses examined whether lactate measurements—obtained from both the colonic vasculature and peripheral circulation before and after surgical correction—could predict short-term survival, alongside histomorphometric assessment of mucosal integrity. Contrary to expectations, colonic venous lactate showed no prognostic value; however, peripheral venous lactate ≥3.2 mmol/L at admission and ≥5 mmol/L post-correction, arterial lactate ≥3.53 mmol/L following manual correction, and mucosal biopsy findings (haemorrhage score ≥3 and interstitium-to-crypt ratio >1) were all significantly associated with poor outcomes. For practitioners, this means that readily accessible peripheral blood sampling—rather than more invasive colonic vein sampling—offers reliable prognostic information intraoperatively, allowing surgeons to have meaningful conversations with owners about realistic survival expectations and to identify candidates where enterotomy or resection may be warranted based on mucosal viability assessment.
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Practical Takeaways
- •Check peripheral lactate before and after manual correction of colon volvulus — values of ≥3.2 mmol/L initially and ≥5 mmol/L post-correction suggest guarded prognosis and warrant honest owner conversations about discharge likelihood
- •If colonic biopsy is obtained, severe mucosal hemorrhage (score ≥3) and abnormal tissue architecture (I:C ratio >1) indicate greater risk of mortality; colonic venous lactate alone is not a reliable prognostic indicator
- •Peripheral and arterial lactate measurements are more clinically useful than colonic venous samples for immediate post-operative prognostication in colic surgery
Key Findings
- •Peripheral venous lactate ≥3.2 mmol/L at admission and ≥5 mmol/L after manual correction were associated with poor short-term outcome
- •Arterial lactate ≥3.53 mmol/L post-correction and mucosal hemorrhage score ≥3 predicted poor prognosis
- •Interstitium to crypt ratio >1 was associated with poor short-term survival
- •Colonic venous lactate values showed no significant association with outcome (P=0.011 before, P=0.201 after correction)