Beyond Lactate: Is There a Role for Serum Lactate Measurement in Diagnosing Acute Mesenteric Ischemia?

Demir, Ihsan Ekin; Ceyhan, Güralp O.; Friess, Helmut

doi:10.1159/000338086

Cited by 121 publications

(96 citation statements)

References 119 publications

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“…In a study by Demir et al, 30 done for identifying factors predicting the need for surgery, elevated CRP was significantly associated with bowel gangrene and an underlying predictive value for the need of surgery. Another study by Lin et al 31 for evaluation of risk factors for intestinal gangrene identified that elevated serum CRP was associated with bowel gangrene.…”

Section: Discussionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction: Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction. Materials and methods:A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).Results: A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively. Conclusion:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

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Section: Discussionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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“…Murray et al demonstrated a significant correlation between the elevation of D-lactate levels and the tissue injury seen in rat models of acute intestinal ischaemia [102]. However, whilst D-lactate may have increased specificity compared to L-lactate in this condition, there is still not enough data to show that it is reliable enough to be used for the diagnosis of acute mesenteric ischaemia [103].…”

Section: The Clinical Significance Of D-lactatementioning

confidence: 99%

Lactic acidosis: an update

Seheult

Fitzpatrick

Boran

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

100

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Lactate is one of the most crucial intermediates in carbohydrate and nonessential amino acid metabolism. The complexity of cellular interactions and metabolism means that lactate can be considered a waste product for one cell but a useful substrate for another. The presence of elevated lactate levels in critically ill patients has important implications for morbidity and mortality. In this review, we provide a brief outline of the metabolism of lactate, the pathophysiology of lactic acidosis, the clinical significance of D-lactate, the role of lactate measurement in acutely ill patients, the methods used to measure lactate in blood or plasma and some of the methodological issues related to interferences in these assays, especially in the case of ethylene glycol poisoning.

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“…(13,21,22) Several prospective clinical studies on lactate levels andacute mesenteric ischemia were conduct , from these studies the two studies conduct 1994 and 1997 by Lange and Jackel and also Lange and Toivola where the authors concluded that even with the high sensitivity of serum lactate the specificity was low which mean that doctors couldn't rely on serum lactate as specific markers. (7,23,24), during the last few years the number of prospective studies comparing the accuracy of several biomarkers were increased and demonstrated the fact that that none of the using biomarkers had the level of accuracy to be used alone as diagnostic markers. (25,26), in 2015 a study was conduct to assess the accuracy of repeated measurement of serum lactate as a marker and the authors reported that there are several factors influenced this accuracy.…”

Section: And6and Figures 56 And7)mentioning

confidence: 99%

“…(12) The results of current study consistence with previous study results that serum lactate is not accurate as the doctors want and need to be combine with other markers to diagnose AMI, however still a lot of doctors rely on serum lactate as diagnostic tool due to the facts that there is no good biomarkers could replace it, it is easy to measure in any laboratory hospital and easy to repeat it . (7,12) During 2009 Evennett et alconduct acomparative analysis study of all major serum markersof acute mesenteric ischemia and they demonstrated D -lactate as the best markers ,(6,7) after that in 2015 study conducted by the authors reported that the D-lactate is a good markers for sever cases with high level of specificity , and recommend to combine it with I-FABP which has high sensitivity and low specificity. (11) …”

Section: And6and Figures 56 And7)mentioning

confidence: 99%

“…(9) Several studies were conduct to investigate the relation between serum lactate and acute mesenteric ischemia, where the results showed that the level of no single serum marker, including serum lactate, is elevated early and specifically enough in the serum to diagnose acute mesenteric ischemia. (7,8) Since that early diagnosis of intestinal ischemia remains a challenge, a further research is required to identify improved serological markers and to demonstrate their clinical utility in the individual patient (6) Our aim in this study is to identify the accuracy of using lactic acid in for early detection of bowel ischemia.…”

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confidence: 99%

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Role of Serum Lactic Acid Level in Diagnosing Mesenteric Bowel Ischemia With the Aid of the Ct Angiogram.

Ayoub¹,

Abdul-Jabbar²,

Sawan³

et al. 2017

IJAR

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Background: Acute mesenteric ischemia is a syndrome caused by inadequate blood flow through the mesenteric vessels, resulting in ischemia and eventual gangrene of the bowel wall; it is a potentially life-threatening condition. This study aimed to identify the specificity and sensitivity of using lactic acid serum level in early detection of bowel ischemia. Method:This is a retrospective study conducted at King Abdulaziz University Hospital from August to October, 2016, enrolled all patients admitted with diagnosis of acute mesenteric bowel ischemia. Result: Out of the 192 cases included in the study, 54.2% of them were males, and 45.8% were females, with mean age score 60.9±17.3, 46 patients(24%) were positive for bowel ischemiaand 21 cases out of them (45.7%) had an operative notes Correlated with CT findings. 2 (1%) cases had no correlation with CT findings, and the rest reported no operation. Less than quarter 44 patients (22.9%) reported suffering from only bowl Ischemia without any risk factors or comorbidity, while 34 patients (17.7%) reported a coexisting several risk factors and other diseases. Approximately 107 patients (55.7%) had high lactic acid level. There was significant relation between lactic acid rang and CT scan findings where more than two third of the cases with positive CT had high lactic acid level (69.6% high vs 30.4% normal, p=0.02) Conclusion: Further studies are needed to be conduct on the base of serial measurements of lactic acidosis and on a base combining serum lactate with other biomarkers such as intestinal fatty acidbinding protein to increase the accuracy of diagnosis.

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Beyond Lactate: Is There a Role for Serum Lactate Measurement in Diagnosing Acute Mesenteric Ischemia?

Cited by 121 publications

References 119 publications

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Lactic acidosis: an update

Role of Serum Lactic Acid Level in Diagnosing Mesenteric Bowel Ischemia With the Aid of the Ct Angiogram.

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