Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study

Abstract

BackgroundIntestinal ischemia is a common complication of intestinal obstruction and arises from impaired perfusion. The resultant local and systemic inflammatory response and bacterial translocation come with a significant degree of morbidity and mortality. This study therefore aimed to investigate the predictive value of elevated levels of serum lactate and phosphate as biomarkers of intestinal ischemia among patients with mechanical intestinal obstruction.MethodsThis was a cross-sectional analytical study done at Mulago Hospital in Uganda. Ethical approval was obtained. All eligible patients had a blood sample drawn for assay analysis. Determination of bowel ischemia status was by physical examination at laparotomy. Analyses were performed using Stata software, version 10.1, and 2 × 2 tables were used to calculate sensitivity and specificity.ResultsSerum lactate was predictive of bowel ischemia, while phosphate was not. Of the 81 patients enrolled 70 qualified for analysis; 40/70 (57%) had ischemic bowel, while 30/70 (43%) had normal bowel. Among those with ischemic bowel, 28/40 (70%) had reversible ischemia, and 12/40 (30%) had irreversible ischemia. Serum lactate assay had a sensitivity of 66% and specificity of 53% for bowel ischemia in general and a higher sensitivity of 71% and specificity of 80% for irreversible bowel ischemia.Lactate was predictive of bowel ischemia in general (p = 0.011), PPV = 14%, but more significantly predictive of irreversible ischemia (p = 0.009), PPV = 42%. NPV for lactate in both forms of ischemia was 93%. Hernias (33/70, 47%) were the most common cause of intestinal obstruction.ConclusionSerum lactate assay had moderate sensitivity for bowel ischemia due to acute mechanical intestinal obstruction. The assay can be used to aid diagnosis of bowel ischemia in low technology settings.

Diagnosis, Management and Outcomes of Intestinal Obstruction at an Urban Tertiary Hospital in Sub Saharan Africa: a Cross-Sectional Study.

“…Our rates of non-operative management in this study (27.3%) compare differently to those in developed countries like USA (73%) and we postulate that could probably be attributed to the lack of alternative methods of non-operative management such as Gastrogra n use in adhesions, hydrostatic or pneumatic reduction of intussusception, as well as the lack of investigative capacity to con rm or rule out bowel ischemia in our setting [16,21,22].…”

The Colonic Single Stripe Sign: A Case of Ischemic Colitis

“…Patients with ischemic colitis often have elevated white blood cell counts, serum lactate, and serum amylase levels. Serum lactate can be used as a predictor of bowel ischemia and is elevated in severe cases of ischemic colitis [6]. Its sensitivity increases in the event of a bowel infarction.…”

Isolated Large Cell Calcifying Sertoli Cell Tumor in a Young Boy, not Associated with Peutz-Jeghers Syndrome or Carney Complex

“…Immunohistochemical stains for NY-ESO-1 (Invitrogen, 1:100 dilution), Calretinin (Zymed 1:50 dilution), Inhibin alpha (Serotec, 1:10 dilution), S100 (BioGenex, 1:8000), PLAP (BioGenex, 1:100), AE1/AE3 (Dako, 1;100 dilution), CD99 (12E7, Dako, 1:100 dilution), Bcl-2 (Dako, 1:20 dilution), Ki-67(Mib1, Dako, 1:200) and P53 (DO-7; DAKO, 1;1000 dilution) were done after antigen retrieval using target retrieval solution, low pH (DAKO) [7]. Slides were incubated in Tris goat (3%) for 15 min and then incubated for 1 to 2 h at room temperature with primary antibodies.…”

“…Images were taken using an Olympus Bx41 microscope, objective UPlanFI 40×/0.75 ∞/0.17, with an adaptor U-TV0.5×C using a digital camera Q-imaging Micropublisher 5.0RTV. The images were captured using “Q-Capture Version 3.1” and imported into Adobe Photoshop 7.0 [7]. …”