Acute mesenteric ischemia: Do biomarkers contribute to diagnosis?

Oliver, Roland; Harsányi, László; Szíjártó, Attila

doi:10.1556/oh.2014.30013

Cited by 6 publications

(6 citation statements)

References 37 publications

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“…Compared with the concentrations of the 5 serum biomarkers preoperatively, α -GST, DAO, D-lactate and I-FABP levels were significantly increased, and citrulline levels were remarkably reduced. These results were similar to those of previous studies assessing biomarkers for the diagnosis of intestinal ischaemia (33)(34)(35). These findings suggest that monitoring changes in these biomarkers after major abdominal surgery may aid in the detection of intestinal mucosal barrier dysfunction to a certain extent.…”

Section: Discussionsupporting

confidence: 90%

Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery

Kong

Yang

et al. 2019

Ann. Transl. Med.

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Background: The aim of this prospective study was to screen and combine effective biomarkers to improve their diagnostic performance in detecting intestinal barrier dysfunction in patients after major abdominal surgery. Methods: Patients undergoing major abdominal surgery were enrolled after signing informed consent in this study. The serum concentrations of α-GST, DAO, D-lactate, citrulline and I-FABP were detected 24 hours before and after surgery. The diagnostic performance of five biomarkers on intestinal barrier dysfunction was assessed using logistic regression models and receiver operating characteristic (ROC) curve analyses. Results: Thirty-nine patients with major abdominal surgery were enrolled in and successfully completed this study. ROC analysis revealed that the sensitivities of D-lactate, citrulline and I-FABP were very high (0.91, 0.91 and 1.00, respectively), but the specificities of these biomarkers were less than 0.70. The sensitivity of DAO was very low [0.25; 95% confidence interval (CI), 0.05-0.57], but its specificity was high (0.92; 95% CI, 0.75-0.99). The accuracies of D-lactate and I-FABP were very high, and the areas under the curves (AUCs) of the biomarkers were 0.84 (95% CI, 0.68-0.93) and 0.81 (95% CI, 0.65-0.92), respectively. Different combinations of five biomarkers were also analysed. The sensitivity, specificity and AUC values of the combination of I-FABP, citrulline and D-lactate were 1.00, 0.74 and 0.89, respectively. These results were similar to those derived from the combination of α-GST, DAO, D-lactate, citrulline and I-FABP (P=1.000). Conclusions: The combination of serum D-lactic acid, citrulline and I-FABP greatly improved the diagnostic performance for identifying intestinal barrier dysfunction in patients after major abdominal surgery.

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Section: Discussionsupporting

confidence: 90%

Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery

Kong

Yang

et al. 2019

Ann. Transl. Med.

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“…Classically, a patient of mesenteric ischemia presents with symptoms more than signs and on laboratory evaluation is found to have metabolic acidosis, raised serum lactate, and leukocytosis [4][5][6]. Leukocytosis with peripheral white blood cell counts exceeding 20 × 10 9 /L has been reported in mesenteric ischemia; this finding alone is not useful to distinguish AMI from other diagnoses as various inflammatory abdominal pathologies present with leukocytosis [9,10]. In our study 22/30 (73.3%) patients had leukocytosis.…”

Section: Discussionmentioning

confidence: 99%

“…Classically, patients with mesenteric ischemia have leukocytosis, metabolic acidosis, and elevated serum lactate. Although total leucocyte counts exceeding 20 × 109/L have been associated with bowel gangrene, this finding is not useful to distinguishing AMI from other etiologies [9,10].…”

Section: Introductionmentioning

confidence: 89%

Triple “L” (Leukocytosis, Lactate, and LDH): Predictors of Mesenteric Ischemia

2020

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To investigate the diagnostic value of total leucocyte counts, plasma lactate dehydrogenase (LDH), and serum lactate levels in combination for diagnosing acute mesenteric ischemia (AMI). This cross-sectional observation study included patients presenting to a tertiary care hospital of Indian Armed Forces with acute abdomen and were found to have mesenteric ischemia at laparotomy. A total of thirty cases of acute abdomen found to have mesenteric ischemia at laparotomy were studied over a period from September 2016 to December 2019. Preoperative leukocytosis, serum lactate levels, and LDH levels were observed in the study population and correlated with intraoperative findings to see whether a preoperative raised value were indicators of mesenteric ischemia when used in combination. A total of 30 patients were observed. Twenty-seven patients were male and 3 were females. Diagnosis was verified at laparotomy. It was observed that 43.3% of the patients had all the three variables positive (raised LDH, lactate, and leukocytosis). At least two of the three variables were positive in 83.3% of the patients of mesenteric ischemia. At least one variable was positive in all patients of mesenteric ischemia. The findings indicate that raised plasma LDH levels, leukocytosis, and serum lactate levels are better predictors of mesenteric ischemia if taken in combinations. In a clinical setting where mesenteric ischemia is suspected, raised levels of at least two of the three markers are indicators of mesenteric ischemia in more than 80% of cases. In case all three markers are negative, mesenteric ischemia is unlikely and alternative diagnosis needs consideration.

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“…17 As a summary, it can be said that early diagnosis is indispensable for an effective treatment, being the only way to keep mortality rates low. [18][19][20]…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

Élthes¹,

Cozlea

Török³

2018

Journal of Cardiovascular Emergencies

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Objective: The aim of the study was to assess the factors associated with increased mortality in patients with acute mesenteric ischemia, emphasizing the importance of an early diagnosis and a prompt surgical intervention in order to avoid lesion progression. Materials and method: A retrospective analytical study was conducted on a study population of 50 male and female patients with acute ischemia of the mesenteric arteries, aged between 36-92 years. Demographic and pathological history characteristics were assessed, together with presented symptoms, laboratory and CT findings, as well as surgical outcome and time-related aspects between presentation in the emergency department and time of surgery, as well as the hospitalization period until discharge or death. Results: Muscular defense (OR = 23.05) and shock (OR = 13.24) as symptoms were strongly associated with a poor prognosis, while elevated values of lactate dehydrogenase (p = 0.0440) and creatine kinase (p = 0.0025) were associated with higher death rates. The time elapsed during investigations in the emergency room was significantly higher in patients who deceased (p = 0.0023), similarly to the total time from the onset of symptoms to the beginning of surgery (p = 0.0032). Surgical outcomes showed that patients with segmental ischemia of the small bowel had significantly higher chances of survival (p <0.0001). Conclusion: Increased mortality rates in patients presenting in the emergency department for acute mesenteric ischemia were observed in patients with occlusion of the superior mesenteric artery, with higher levels of CK and LDH, as well as with longer periods of stay in the emergency department for diagnostic procedures until the commencement of the surgical intervention. Therefore, proper investigations in a timely manner followed by a specific and prompt surgical intervention may avoid unfavorable evolution of patients towards death.

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Acute mesenteric ischemia: Do biomarkers contribute to diagnosis?

Cited by 6 publications

References 37 publications

Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery

Screening and combining serum biomarkers to improve their diagnostic performance in the detection of intestinal barrier dysfunction in patients after major abdominal surgery

Triple “L” (Leukocytosis, Lactate, and LDH): Predictors of Mesenteric Ischemia

Factors Associated With in-Hospital Death in Patients with Acute Mesenteric Artery Ischemia

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