Plasma lactate as a predictor of colonic viability and survival after 360 degrees volvulus of the ascending colon in horses.
Authors: Johnston Kimberly, Holcombe Susan J, Hauptman Joe G
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Ascending colon volvulus represents a life-threatening colic presentation, yet clinical decision-making regarding prognosis and surgical intervention remains challenging. Johnston and colleagues conducted a retrospective analysis of 73 horses with ≥360° volvulus of the ascending colon, examining whether preoperative plasma lactate concentrations could predict tissue viability and patient survival using logistic regression modelling of historical data spanning 2000–2005. Survivors demonstrated markedly lower mean lactate levels (2.98 mmol/L) compared with non-survivors (9.48 mmol/L), with each 1 mmol/L increase in lactate conferring a 1.63-fold increased odds of mortality; similarly, viable colons showed mean lactate of 3.30 mmol/L versus 9.1 mmol/L in non-viable tissue. A preoperative lactate threshold of <6.0 mmol/L provided 84% sensitivity and 83% specificity for predicting survival, offering clinicians a quantifiable prognostic marker at the point of hospital admission. For practitioners managing acute colic cases, these findings suggest that preoperative lactate measurement could meaningfully inform discussions with owners regarding surgical candidacy and tissue prognosis, particularly in distinguishing cases with viable versus devitalised colon that might otherwise appear clinically similar on presentation.
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Practical Takeaways
- •Measure plasma lactate preoperatively in horses with suspected ascending colon volvulus—a value <6.0 mmol/L is a favorable prognostic indicator for survival with 84% accuracy
- •High lactate (>9.5 mmol/L) suggests extensive colonic damage and poor viability, helping inform surgical decision-making and owner counseling on realistic survival odds
- •Use lactate concentration alongside clinical signs and imaging to guide urgency of intervention and predict need for extensive resection or euthanasia
Key Findings
- •Mean plasma lactate concentration was significantly lower in survivors (2.98 mmol/L) versus non-survivors (9.48 mmol/L; OR=1.628)
- •Plasma lactate <6.0 mmol/L had 84% sensitivity and 83% specificity for predicting survival
- •Viable colon tissue had significantly lower lactate (3.30 mmol/L) compared to non-viable colon (9.1 mmol/L; OR=1.472)
- •61 of 73 horses (84%) were discharged alive