Serum D(-)-lactate levels as an aid to diagnosing acute intestinal ischemia.
No serum marker has consistently proved helpful in diagnosing early acute mesenteric ischemia. D(-)-lactate is a product of bacterial metabolism and was found to be elevated in peripheral blood in a rat model of intestinal ischemia. We conducted a prospective study to evaluate preoperative D(-)-lactate levels in 31 patients undergoing laparotomy for acute abdominal emergencies, including suspected acute mesenteric ischemia. The serum was deproteinated and D(-)-lactate concentration was determined by a spectrophotometric assay. A control group was composed of patients with a benign abdominal examination who were operated on for central venous line placement. We found significant elevations in D(-)-lactate levels in patients with mesenteric ischemia compared with controls (P < 0.00005), as well as in patients with other forms of abdominal catastrophes (P < 0.00005) and with bowel obstruction (P < 0.0005). Sensitivity and specificity were 90% and 87%, respectively. The negative predictive value was 96%, and the positive predictive value was 70%. We have found that D(-)-lactate serum levels can aid in diagnosing acute mesenteric ischemia.
Murray
M J
MJ
Department of Surgery, Medical College of Pennsylvania, Pittsburgh.
Gonze
M D
MD
Nowak
L R
LR
Cobb
C F
CF
D000208:Acute Disease; D004796:Clinical Enzyme Tests; D004066:Digestive System Diseases / Q000175:diagnosis; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis*; D007773:Lactates / Q000097:blood*; D019344:Lactic Acid; D008643:Mesentery / Q000098:blood supply*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013053:Spectrophotometry
D007773:Lactates; D019344:Lactic Acid