title: The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia.
abstract: BACKGROUND
  Acute mesenteric ischemia (AMI) is an emergency with a mortality rate up to 50%. Detecting AMI continues to be a major challenge. This study assed the correlation of repeated preoperative serum lactate with bowel necrosis and to identify risk factors for a lethal outcome in patients with AMI.
  
  
  METHODS
  A retrospective study of 91 patients with clinically and pathologically confirmed AMI from January 2006 to December 2012 was performed.
  
  
  RESULTS
  In-hospital mortality rate was 42.9%. Two hundred nine preoperative lactate measurements were analyzed (2.3 ± 1.1 values per patient). Less than or equal to six hours prior to surgery, the mean serum lactate level was significantly higher (4.97 ± 4.21 vs. 3.24 ± 3.05 mmol/L, p = 0.006) and the mean pH significantly lower (7.28 ± 0.12 vs. 7.37 ± 0.08, p = 0.001) compared to >6 h before surgery. Thirty-four patients had at least two lactate measurements within 24 h prior to surgery. In this subgroup, 17 patients (50%) exhibited an increase, 17 patients (50%) a decrease in lactate levels. Forward logistic regression analysis showed that length of necrotic bowel and the highest lactate value 24 h prior to surgery were independent risk factors for mortality (r2  = 0.329).
  
  
  CONCLUSIONS
  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.
authors: Department of Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
authors: Peter
authors: P
authors: Studer
authors: Adrian
authors: A
authors: Vaucher
authors: Daniel
authors: D
authors: Candinas
authors: Beat
authors: B
authors: Schnüriger
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D065666:Mesenteric Ischemia / Q000097:blood* / Q000401:mortality* / Q000601:surgery; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D019344:Lactic Acid
references: World J Surg. 2009 Jul;33(7):1374-83
references: 19424744
references: Am J Surg. 1994 Jun;167(6):575-8
references: 8209931
references: Radiology. 2010 Jul;256(1):93-101
references: 20574087
references: Lakartidningen. 1997 May 14;94(20):1893-6
references: 9190479
references: Best Pract Res Clin Gastroenterol. 2001 Feb;15(1):83-98
references: 11355902
references: Am Surg. 2003 Apr;69(4):324-9; discussion 329
references: 12716091
references: Am J Surg. 1977 Feb;133(2):188-93
references: 835791
references: Scand J Clin Lab Invest. 2008;68(3):242-8
references: 17934974
references: Semin Vasc Surg. 2010 Mar;23(1):4-8
references: 20298944
references: Surgery. 1993 Sep;114(3):489-90
references: 8367801
references: Zentralbl Chir. 2005 Jun;130(3):223-6
references: 15965874
references: J Thromb Thrombolysis. 2012 May;33(4):355-61
references: 22081293
references: J Emerg Med. 2012 Jun;42(6):635-41
references: 22137151
references: Radiology. 1995 Oct;197(1):79-82
references: 7568858