Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA.
Equine Vet J. 2024 May;56(3):437-448. doi: 10.1111/evj.13977. Epub 2023 Aug 4.
Early identification of strangulating obstruction (SO) in horses with colic improves outcomes, yet early diagnosis of horses requiring surgery for SO often remains challenging.
To compare blood and peritoneal fluid l-lactate concentrations, peritoneal:blood l-lactate ratio, peritoneal minus blood (peritoneal-blood) l-lactate concentration and other clinical variables for predicting SO and SO in horses with small intestinal lesions (SO-SI) and then to develop a multivariable model to predict SO and SO-SI.
Retrospective cohort.
A total of 197 equids admitted to a referral institution for colic between 2016 and 2019 that had peritoneal fluid analysis performed at admission were included. Twenty-three admission variables were evaluated individually for the prediction of a SO or SO-SI and then using multivariable logistic regression. Odds ratios (ORs) with 95% confidence intervals (CI) and area under the curve of the receiver operator characteristic (AUC ROC) were calculated.
All variables performed better in the model than individually. The final multivariable model for predicting SO included marked abdominal pain (OR 5.31, CI 1.40-20.18), rectal temperature (OR 0.30, CI 0.14-0.64), serosanguineous peritoneal fluid (OR 35.34, CI 10.10-122.94), peritoneal-blood l-lactate (OR 1.77, CI 1.25-2.51), and peritoneal:blood l-lactate ratio (OR 0.36, CI 0.18-0.72). The AUC ROC was 0.91. The final multivariable model for predicting SO-SI included reflux volume (OR 0.69, CI 0.56-0.86), blood l-lactate concentration (OR 0.43, CI 0.22-0.87), serosanguineous peritoneal fluid (OR 4.99, CI 1.26-19.74), and peritoneal l-lactate concentration (OR 3.77, CI 1.82-7.81).
Retrospective, single-hospital study design.
Blood and peritoneal fluid l-lactate concentrations should be interpreted in conjunction with other clinical variables. The relationship between peritoneal and blood l-lactate concentration for predicting SO or SO-SI was complex when included in a multivariable model. Models to predict SO probably vary based on lesion location.
早期识别腹痛（SO）的绞窄性梗阻可改善预后，但对于需要手术治疗 SO 的马匹，早期诊断往往仍然具有挑战性。
比较血液和腹腔液 l-乳酸浓度、腹腔：血液 l-乳酸比值、腹腔减血液（腹腔-血液）l-乳酸浓度和其他临床变量，以预测 SO 和具有小肠病变的 SO（SO-SI），然后建立多变量模型预测 SO 和 SO-SI。
回顾性队列研究。
纳入 2016 年至 2019 年在一家转诊机构因腹痛就诊并在入院时进行腹腔液分析的 197 例马属动物。单独评估 23 个入院变量，以预测 SO 或 SO-SI，然后使用多变量逻辑回归。计算比值比（OR）及其 95%置信区间（CI）和接收者操作特征曲线下面积（AUC ROC）。
所有变量在模型中的表现均优于个体表现。预测 SO 的最终多变量模型包括明显的腹痛（OR 5.31，CI 1.40-20.18）、直肠温度（OR 0.30，CI 0.14-0.64）、血清血性腹腔液（OR 35.34，CI 10.10-122.94）、腹腔-血液 l-乳酸（OR 1.77，CI 1.25-2.51）和腹腔-血液 l-乳酸比值（OR 0.36，CI 0.18-0.72）。AUC ROC 为 0.91。预测 SO-SI 的最终多变量模型包括反流量（OR 0.69，CI 0.56-0.86）、血液 l-乳酸浓度（OR 0.43，CI 0.22-0.87）、血清血性腹腔液（OR 4.99，CI 1.26-19.74）和腹腔 l-乳酸浓度（OR 3.77，CI 1.82-7.81）。
回顾性、单医院研究设计。
应结合其他临床变量来解释血液和腹腔液 l-乳酸浓度。当包含在多变量模型中时，预测 SO 或 SO-SI 的腹膜和血液 l-乳酸浓度之间的关系很复杂。预测 SO 的模型可能因病变部位而异。
