Diagnostic accuracy of plasma biomarkers for intestinal ischaemia

Block, Tomas; Nilsson, Torbjörn; Björck, Martin; Acosta, Stefan

doi:10.1080/00365510701646264

Cited by 157 publications

(131 citation statements)

References 34 publications

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“…In their other study, blood was taken in order to analyse D-dimer levels of 101 patients within 24 hours from the onset of abdominal pain and 9 of them were found to be SMA occluded and in these patients median D-dimer levels were elevated signifi cantly (10). In a more recent prospective study, D-dimer was analysed alongside with alpha-glutathion S-transferase, I-FABP, creatinine kinase, lactate dehydrogenase and alkaline phosphatase and only D-dimer was found to be relevant with AMI but this test was not specifi c enough for the diagnosis (13). In experimental studies, D-dimer levels were tested at different time points after SMA occlusion and Altinyollar et al and Kurt et al reported signifi cant elevation 30 minutes and 2 hours after ischemia, respectively (12,30).…”

Section: Discussionmentioning

confidence: 99%

“…Thus, it is reported in a study that 9 of the test samples were taken at emergency ward and 5 were taken at general surgery ward or intensive care unit (29). In other studies D-dimer tests were made within 24 hours from the onset of abdominal pain, so it is hard to evaluate if this test can be used for early diagnosis (10,13). Previous studies have shown similar results in the meaning of D-dimer elevations in SMA occluded rats, but in our study this elevation was not statistically signifi cant.…”

Section: Discussionmentioning

confidence: 99%

“…Even though serum amylase, aspartate aminotransferase (AST), lactate dehydrogenase (LDH) and creatine phosphokinase (CPK) are elevated, none of these are sensitive or specifi c (7). There are a lot of studies investigating the serum levels of D-dimer, alpha-glutathion S-transferase, Dlactate, L-lactate, LDH, intestinal fatty acid binding protein, alkaline phosphatase and CPK for early diagnosis of AMI but there are controversial reports about the usage of these markers in early diagnosis of instestinal ischaemia (10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

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The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Aydın¹,

Ozban²,

Serinken³

et al. 2015

BLL

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INTRODUCTION: Acute mesenteric ischemia (AMI) is an abdominal-vascular emergency which is rare and has high mortality rates (60-80 %) due to late diagnosis (1-3). Although it is known that extravascular reasons like intestinal intussusception, volvulus, strangulated hernias and obstructions can cause intestinal gangrene, these are rarely the cause of AMI (1). MATERIALS AND METHODS: In this study, we used male Wistar-Albino rats weighing 250-300 grams obtained from Pamukkale University Experimental Research Laboratory. Animals were exposed to light-dark cycles for 12 hours and had free access to food and water. They were kept in cages for 7 days to stabilise their intestinal fl ora. In animals of group I, nothing was made other than taking 0.5 ml blood intracardially. In other animals, abdomen was reached with midline laparotomy and superior mesenteric artery (SMA) was located. In group II (operative control group), SMA was isolated and manipulated but was not ligated. In Group III (intestinal ischemia group), SMAwas isolated and ligated with 3/0 silk tie distally to the aorta. After this process, intestinal ischemia was achieved which was confi rmed by paleness and pulselessness of intestines, caecum and right colon. Later on, abdomen was closed with double 3/0 polyglactin sutures. At postoperative 1st, 4th and 6th hours 0.5 ml blood was taken intracardially from the animals in groups II and III in order to quantify D-dimer and L-lactate levels. LABORATORY TESTS: D-dimer: Blood samples which were put into tubes containing sodium citrate, were seperated from plasma with centrifugation at 4000 rpm for 7 minutes. L-lactate: Blood L-lactate levels were determined from blood taken into capillary tubes with the help of immobilised enzyme electrode technology using YSI 1500 Sport portative lactate analyzer (Yellow Springs Instruments Inc., Ohio-USA). HISTOPATHOLOGIC VERIFICATION: Two cm long intestinal samples were taken from animals in which SMA was ligated in order to achieve mesenteric ischemia and these samples were fi xed in 10 % formol. DISCUSSION: As a result, in rats with SMA occlusion serum D-dimer levels were not increased signifi cantly when compared either in the group or with the basal values of the control group and values in operative control group. Therefore, it is concluded that D-dimer is not a useful marker for early diagnosis of AMI. On the other hand, it is revealed that blood L-lactate levels began to increase signifi cantly following 4th hour of mesenteric ischemia and it is shown that this increase continued at the 6th hour. In addition, considering the utmost importance of the early diagnosis in patients with the clinical suspicion of AMI, L-lactate seems to be a suitable marker to use in emergency departments because it is achieved with a portable device that gives fast and accurate results. Nevertheless, our results are need to be supported by clinical studies with larger patient series (Tab. 2, Fig. 11, Ref. 39). Text in PDF www.elis.sk.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

Aydın¹,

Ozban²,

Serinken³

et al. 2015

BLL

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“…D-dimer has been reported to be an independent risk factor of intestinal ischemia [27], reflecting ongoing clot formation and endogenous degradation via fibrinolysis. No patient presenting with a normal D-dimer had intestinal ischemia and D-dimer >0.9 mg/L had a specificity, sensitivity, and accuracy of 82, 60, and 79%, respectively [28]. Thus, Ddimer may well be useful in the early assessment.…”

Section: (Recommendation 1b)mentioning

confidence: 99%

Acute Mesenteric Ischemia

Bala¹,

Kashuk²

2016

Acute Care Surgery Handbook

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“…При ОНМК, кроме лейкоцитоза, метаболического ацидоза, лактата крови, отмечают повышение по-казателей D-димеров, [19]. Считается, что высокий лейкоцитоз (более 20×10 9 /л) не позволяет отличить ОНМК от других заболеваний [28,29]. В проспек-тивных клинических исследованиях классически описывается метаболический ацидоз [30], а перво-начальный анализ газов крови показал, что метабо-лический алкалоз наблюдается чаще, чем ацидоз, и это происходит при тяжелой рвоте во время раннего периода ишемии кишечника.…”

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