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

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. 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, suggest that exploratory laparotomy should be advised irrespective of the blood lactate level.