The Value of Serial Serum Lactate Measurements in Predicting the Extent of Ischemic Bowel and Outcome of Patients Suffering Acute Mesenteric Ischemia

Abstract

The value of serial lactate and pH measurements to predict the length of necrotic bowel is very limited. Length of necrotic bowel and lactate values are independent risk factors for mortality.

Editor's Choice – Management of the Diseases of Mesenteric Arteries and Veins

“…52,53 In one study the mean plasma lactate level was doubled from the upper reference limit late in the course after a median symptom duration of 43 hours, which probably explains the elevated lactate levels and the high (90%) post-operative 30 day mortality. 55 Lactate levels were normal early in the course, 48e50%, 53,56 in two recent reports, suggesting that plasma lactate is a poor marker of early AMI. In a series of 34 patients with at least two available arterial blood gas lactate measurements within 24 hours before surgery, 17 (50%) exhibited an increase, and 17 (50%) a decrease in lactate levels.…”

“…The authors concluded that the value of serial lactate and pH measurements in predicting the extent of intestinal ischaemia seems to be very limited. 56 There is common agreement that lactate is a marker of general deterioration, systemic hypoperfusion, and death, no matter the cause. 56,57 Experimental work suggests, however, that lactate produced within the porto-mesenteric venous circulation is effectively metabolised by the liver.…”

Role of Serum Lactic Acid Level in Diagnosing Mesenteric Bowel Ischemia With the Aid of the Ct Angiogram.

“…(7) 879 several studies (case series, experimental and prospective) since 1970s conduct to investigate the effectiveness of using serum lactate levels changes as a reliable biomarker of AMI. (12,13) One of the early case series study to detect the relation between high serum lactate level and AMI was the study of Janda et alin 1984 followed by Nutz and Sommer study in 1987 , where the author of both studies demonstrated increasing in the level of serum lactate among AMI patients and explained that by the increasing in demands of blood and oxygen by intestine and increase the depending on anaerobic metabolism causing acidosis and a serum lactic acid increase (lactacidemia), however both studies didn't include time factor between onset of ischemia and time of diagnosis . (7,14,15,) On the other hand, in USA study the authors addressed several factors influence the effectiveness of the markers: site, amount, releasing mechanism, separating from the serum and specificity for the intestine.…”

“…(12) The results of current study consistence with previous study results that serum lactate is not accurate as the doctors want and need to be combine with other markers to diagnose AMI, however still a lot of doctors rely on serum lactate as diagnostic tool due to the facts that there is no good biomarkers could replace it, it is easy to measure in any laboratory hospital and easy to repeat it . (7,12) During 2009 Evennett et alconduct acomparative analysis study of all major serum markersof acute mesenteric ischemia and they demonstrated D -lactate as the best markers ,(6,7) after that in 2015 study conducted by the authors reported that the D-lactate is a good markers for sever cases with high level of specificity , and recommend to combine it with I-FABP which has high sensitivity and low specificity. (11) …”

Duplex ultrasound in the early diagnosis of acute mesenteric ischemia: a longitudinal cohort multicentric study

“…These include abdominal pain in 96% of cases, which is often out of proportion to the examination findings, vomiting, nausea, and diarrhea [11]. The initial assessment includes plain radiography and blood tests, which are frequently nondiagnostic, although an elevated lactate may suggest the diagnosis [12,13]. Multidetector computed tomography (MDCT) and computed tomography (CT) angiography are considered the gold-standard imaging techniques to confirm the diagnosis as catheter angiography is invasive, costly, and not available in all facilities [14,15].…”