A Review of the Predictive Role of Plasma D-Lactate Level in Acute Appendicitis: A Myth or Truth?

Abstract

Acute appendicitis (AA) is a common condition which warrants emergency surgery. Detailed history, physical exam, and laboratory findings are often nonspecific in suspected patients. There is substantial evidence to indicate that plasma levels of D-lactate were useful to establish a diagnosis of AA in the medical literature. It has been suggested that it is useful for patients with abdominal pain, especially patients with perforated AA. This paper is designed to highlight the value of D-lactate biomarker in establishing a diagnosis of AA. Based on the literature, it is not helpful for a decision of operation in patients with AA. According to the results of the studies, laboratory involvement was observed between plasma D-lactate level and the final diagnosis of AA, particularly in perforated appendices. It can be considered for routine use in patients with undifferentiated abdominal pain in the emergency department setting.

D-Lactate: Implications for Gastrointestinal Diseases

“…These diseases share pathophysiological similarities, including dysbiosis, with a possible overgrowth of D-lactate-producing bacteria, which displace the healthy gut microbiota [ 54 , 72 , 74 , 76 , 87 ]. Dysbiosis also contributes to the impairment of the intestinal barrier [ 95 ], which then allows translocation of D-lactate into the bloodstream [ 55 , 62 , 71 , 96 ]. Overall, it can be postulated that, in addition to increased bacterial D-lactate production, an alteration of the intestinal barrier is required to increase blood D-lactate levels in these diseases.…”

Factors associated with serious abdominal conditions in geriatric patients visiting the emergency department

“…Variables associated with poor outcomes included age > 84 years, bandemia, intra-abdominal free air, hypotension, abnormal bowel sounds, dilated loops of bowel, and extreme leukocytosis [ 7 ]. Laboratory data used to diagnose acute appendicitis and bowel ischemia include red blood cell distribution width (RDW), mean platelet volume (MPV), and lactate but laboratory data cannot predict the outcome of serious abdominal conditions [ 8 – 11 ].…”