Increased Circulating D-Lactate Levels Predict Risk of Mortality After Hemorrhage and Surgical Trauma in Baboons

Abstract

Patients with hemorrhagic shock and/or trauma are at risk of developing colonic ischemia associated with bacterial translocation that may lead to multiple organ failure and death. Intestinal ischemia is difficult to diagnose noninvasively. The present retrospective study was designed to determine whether circulating plasma D-lactate is associated with mortality in a clinically relevant two-hit model in baboons. Hemorrhagic shock was induced in anesthetized baboons (n = 24) by controlled bleeding (mean arterial pressure, 40 mmHg), base excess (maximum -5 mmol/L), and time (maximum 3 h). To mimic clinical setting more closely, all animals underwent a surgical trauma after resuscitation including midshaft osteotomy stabilized with reamed femoral interlocking nailing and were followed for 7 days. Hemorrhagic shock/surgical trauma resulted in 66% mortality by day 7. In nonsurvivor (n = 16) hemorrhagic shock/surgical trauma baboons, circulating D-lactate levels were significantly increased (2-fold) at 24 h compared with survivors (n = 8), whereas the early increase during hemorrhage and resuscitation declined during the early postresuscitation phase with no difference between survivors and nonsurvivors. Moreover, D-lactate levels remained elevated in the nonsurvival group until death, whereas it decreased to baseline in survivors. Prediction of death (receiver operating characteristic test) by D-lactate was accurate with an area under the curve (days 1-3 after trauma) of 0.85 (95% confidence interval, 0.72-0.93). The optimal D-lactate cutoff value of 25.34 μg/mL produced sensitivity of 73% to 99% and specificity of 50% to 83%. Our data suggest that elevation of plasma D-lactate after 24 h predicts an increased risk of mortality after hemorrhage and trauma.

Plasma biomarkers for early diagnosis of acute intestinal ischemia

“…Additional studies have confirmed that extended elevations correlate with bacteremia likely due to increased bacterial translocation. Elevated D-lactate levels at 48 hours can be predictive of morbidity and mortality [19,20].…”

Temporal relationship of serum markers and tissue damage during acute intestinal ischemia/reperfusion

“…The temporal dynamics of tight-junction alterations in the intestinal mucosa, thought to be a basis for barrier dysfunction after IR (32), could partly explain this result. Additionally, experimental studies in primates have shown that serum D-lactate levels can predict mortality in models of hemorrhagic shock (33). This adds to the possible clinical value of D-lactate as a biomarker in settings of intestinal IR.…”

A, B, C, D, echo

“…30 Some of these patients with a history of hypotension will ''respond'' to fluid resuscitation initially only to later die of bleeding. 32 This indicator however is a sign of cellular hypoxia, regardless of the cause. 32 This indicator however is a sign of cellular hypoxia, regardless of the cause.…”