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

Abstract

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.

A prospective study of serum C-reactive protein and D-lactate levels for early prediction of strangulation in intestinal obstruction

“…For predicting strangulation, using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 87.5, 58.3, 48.3, and 91.3% respectively. 9 In our study mean D-lactate level was 5.2±0.62 mmol/L in group A and mean D-lactate level was 2.87±1.04 mmol/Lin group B. The mean D-lactate level differences in both groups were statistically significant.…”

Wael's surgical treatment of intestinal gangrene due to congenital internal hernia: A case report and review of literature

“…There were some studies evaluated the promising clinical value of D‐lactate measurements in patients with acute abdomen and concluded an improvement in the diagnosis of acute intestinal ischemia 18,19 . Also, another study revealed an increased values of serum D‐lactate in patients had strangulated bowel obstruction 20 . Unfortunately, rarely D‐lactate levels raised during the early phase of intestinal ischemia.…”

New Biomarkers of Acute Mesenteric Ischemia

“…В отличие от L-лактата, являющегося продуктом метаболиз-ма клеток организма человека, его повышение указывает на нарушение целостности кишечной стенки. Однако проведенные эксперименталь-ные и клинические исследования показали, что уровень D-лактата имеет низкие показатели специфичности (20%) при высокой чувстви-тельности (до 90%) [27,30,31]. Кроме этого, повышение в крови D-лактата указывает на уже состоявшийся некроз кишки, что ухудшает прогноз этой категории пациентов.…”

“…Авторами показано, что чувствительность D-лактата выше, чем С-реактивного белка, однако ни у того, ни у другого не получено достаточных для использования в клинике по-казателей чувствительности и специфичности. В связи с этим авторы предлагают использовать эти два показателя вместе [31].…”

“…Сердечную изоформу этого белка используют для ранней диагностики инфаркта миокарда [17,18]. При ОИИ по результатам клинических и экспериментальных исследований [21,28,30,31,35,36,37, 38] он показал чувствительность 80%, специфичность -85%. Однако в экспери-ментальном исследовании Z.D.…”