Gastric dilatation volvulus in dogs: utility of lactate as a predictor of survival

Abstract

PICO question In dogs presenting with gastric dilatation volvulus, is an admission or pre-operative lactate level a reliable predictor of survival to discharge?   Clinical bottom line Category of research question Prognosis The number and type of study designs reviewed 15 studies (12 retrospective and 3 prospective) were critically appraised Strength of evidence Moderate Outcomes reported At a population level, lower blood lactate concentration, or lactate concentration that decreases following fluid resuscitation, are associated with a better prognosis. At a population level, higher blood lactate concentration, or lactate concentration that fails to decrease following fluid resuscitation, is associated with a worse prognosis. However, the lower sensitivity across studies means that a high lactate, or one that does not decrease following fluid therapy, should be interpreted more cautiously than a low lactate; i.e., low lactate predicts survival better than high lactate predicts non-survival. In all studies, there was a significant overlap in individual blood lactate concentration between survivors and non-survivors Conclusion Blood lactate level should only be used to help guide broad, cautiously worded conversations with owners as described above. It should not be used to give a prognosis for individual patients. The overlap between survivors and non-survivors, and the high overall survival rate, means that exploratory laparotomy should be advised irrespective of the blood lactate level   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.