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

Abstract

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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