Alactic base excess is not a sensitive or specific diagnostic tool for outcome in horses with colic.
Abstract: Colic is a significant source of morbidity and mortality in horses, and no single biomarker can distinguish surgical from medical colic or predict mortality. Alactic base excess (ABE) has shown an association with mortality and renal insufficiency in humans but has not been evaluated in veterinary species. The purpose of this study was to determine the value of ABE as a diagnostic tool for horses treated for gastrointestinal disease. Unassigned: This retrospective case series evaluated horses admitted for acute gastrointestinal disease over a 5-year period (2019-2024). Signalment, physical examination findings, venous blood gas analysis results, packed cell volume and total solids on admission, findings in cases undergoing exploratory celiotomy, and outcome were collected from the medical record. Variables were evaluated individually, and by multivariate analysis for sensitivity and specificity to differentiate medical from surgical colic, strangulating versus non-strangulating lesions, and between survivors and non-survivors after surgical intervention. Optimal Youden cut-off values and area under the receiver operating curve (AUC) were calculated. Unassigned: Five hundred and thirty eight horses met the inclusion criteria. Multiple presentations by the same horse were each counted as individual presentations, resulting in 585 admissions. While ABE was higher in surgical cases that did not survive ( = 0.029), it did not discriminate between medical and surgical colic or between survivors and non-survivors as a sole diagnostic or multivariate modality. The best predictor of medical or surgical treatment was serum glucose levels (AUC = 0.76, Se = 0.76, Sp = 0.67). Serum glucose levels were also the best predictor of strangulating versus non-strangulating lesions (AUC = 0.81, Se = 0.67, Sp = 0.83). The model for survival after surgery included age and serum L-lactate (AUC = 0.76, Se = 0.73, Sp = 0.69). Unassigned: Elevations in alactic base excess values in surgical cases that did not survive may indicate compensation for hyperlactatemia with complex metabolic derangements. Our investigation supports the use of hyperglycemia and hyperlactatemia as markers of severity for horses with gastrointestinal disease.
Copyright © 2025 Crosby, O’Connor and Munsterman.
Publication Date: 2025-08-15 PubMed ID: 40895787PubMed Central: PMC12396145DOI: 10.3389/fvets.2025.1618304Google Scholar: Lookup
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Summary
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Overview
- This study evaluated the effectiveness of alactic base excess (ABE) as a diagnostic tool to predict outcomes in horses with colic and found that ABE is neither sensitive nor specific for distinguishing types of colic or predicting survival.
- Instead, serum glucose and lactate levels were found to be better indicators for determining the type of colic and survival prognosis after surgery in horses with gastrointestinal disease.
Background and Purpose
- Colic is a serious condition in horses causing high rates of illness and death, often requiring quick and accurate diagnosis to determine if surgery is needed.
- Currently, no single biomarker clearly differentiates medical (non-surgical) from surgical colic or predicts horse survival.
- Alactic base excess (ABE) is known in humans to be associated with mortality and kidney issues but had not been previously studied in horses.
- The study aimed to investigate whether ABE could serve as a useful diagnostic or prognostic biomarker in horses presenting with acute gastrointestinal disease.
Study Design and Methods
- Retrospective case series reviewing medical records from 2019 to 2024 involving horses admitted with acute gastrointestinal disease.
- Collected data included:
- Signalment (age, breed, sex),
- Physical examination findings at admission,
- Venous blood gas analysis (including ABE measurements),
- Packed cell volume (PCV) and total solids (TS),
- Findings from exploratory celiotomy for surgical cases,
- Outcome (survival or non-survival).
- Each individual presentation was treated as a separate case, leading to 585 admissions from 538 horses.
- Statistical analyses included:
- Individual variable evaluation,
- Multivariate analyses to assess sensitivity (Se) and specificity (Sp) for:
- Differentiating medical vs. surgical colic,
- Distinguishing strangulating vs. non-strangulating lesions,
- Predicting survival vs. non-survival after surgery.
- Calculation of optimal cut-off values using Youden’s index and area under the receiver operating characteristic curve (AUC) for predictive performance.
Key Findings
- ABE was significantly higher in surgical cases that did not survive (p = 0.029), suggesting a potential association but not sufficient discrimination power for diagnostic use.
- ABE did not effectively differentiate:
- Medical versus surgical colic cases,
- Strangulating versus non-strangulating lesions,
- Survivors versus non-survivors when used alone or in combination with other variables.
- Serum glucose levels were the most reliable predictor of:
- Whether colic required medical or surgical intervention (AUC = 0.76, Se = 0.76, Sp = 0.67),
- Distinguishing strangulating from non-strangulating lesions (AUC = 0.81, Se = 0.67, Sp = 0.83).
- For survival prediction post-surgery, the best model included:
- Age of the horse,
- Serum L-lactate levels (AUC = 0.76, Se = 0.73, Sp = 0.69).
Interpretation and Implications
- Elevated alactic base excess in non-surviving surgical horses may reflect complex metabolic disturbances possibly compensating for high lactate levels rather than serving as a straightforward predictive marker.
- The study supports the clinical use of serum glucose and lactate as more valuable biomarkers for assessing severity, guiding treatment decisions, and prognostication in horses with gastrointestinal disease.
- These findings indicate ABE should not be relied upon alone or as the primary diagnostic tool for outcome prediction in equine colic.
- Clinicians may consider focusing on glucose and lactate measurements during initial assessments and when planning surgical intervention or providing prognosis.
Cite This Article
APA
Crosby CE, O'Connor A, Munsterman AS.
(2025).
Alactic base excess is not a sensitive or specific diagnostic tool for outcome in horses with colic.
Front Vet Sci, 12, 1618304.
https://doi.org/10.3389/fvets.2025.1618304 Publication
Researcher Affiliations
- Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States.
- Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States.
- Department of Large Animal Clinical Sciences, Michigan State University College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States.
Conflict of Interest Statement
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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