title: Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia.
abstract: BACKGROUND
  The prognostic value of biochemical tests in critically ill patients with multiple organ failure and suspected bowel ischemia is unknown.
  
  
  METHODS
  In a prospective observational cohort study intensive care patients were included when the attending intensivist considered intestinal ischemia in the diagnostic workup at any time during intensive care stay. Patients were only included once. When enrolment was ended each patient was classified as 'proven intestinal ischemia', 'ischemia likely', 'ischemia unlikely' or 'no intestinal ischemia'. Proven intestinal ischemia was defined as the gross disturbance of blood flow in the bowel, regardless of extent and grade. Classification was based on reports from the operating surgeon, pathology department, endoscopy reports and CT-scan. Lactate dehydrogenase (LDH), creatine kinase (CK), alanine aminotransferase (ALAT), L-lactate were available for the attending physician. D-lactate and intestinal fatty acid binding protein (I-FABP) were analysed later in a batch. I-FABP was only measured in patients with proven ischemia or no ischemia.
  
  
  RESULTS
  For 44 of the 120 included patients definite diagnostic studies were available. 23/44 patients (52%) had proven intestinal ischemia as confirmed by surgery, colonoscopy, autopsy and/or histopathological findings. LDH in these patients was 285 U/l (217-785) vs 287 U/l (189-836) in no-ischemia; p = 0.72. CK was 226 U/l in patients with proven ischemia (126-2145) vs 347 U/l (50-1427), p = 0.88. ALAT was 53 U/l (18-300) vs 34 U/l (14-34), p-0,56. D-lactate 0.41 mmol/l (0.11-0.75) vs 0.56 mmol/l (0.27-0.77), p = 0.46. L-lactate 3.5 mmol/l (2.2-8.4) vs 2.6 mmol/l (1.7-3.9), p = 0.09. I-FABP 2872 pg/ml (229-4340) vs 1020 pg/ml (239-5324), p = 0.98. Patient groups proven and likely ischemia together compared to unlikely and no-ischemia together showed significant higher L-lactate (p = 0.001) and higher D-lactate (p = 0.003).
  
  
  CONCLUSIONS
  Measurement of LDH, CK, and ALAT did not discriminate critically ill patients with proven intestinal ischemia from those with definite diagnosis no-ischemia. However, L-lactate and D-lactate levels were higher in patients with proven or likely ischemia and need further study just as I-FABP.
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands ; TIAS business school of Tilburg University, Tilburg, The Netherlands.
authors.forename: Peter H J
authors.initials: PH
authors.lastname: van der Voort
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.
authors.forename: Berit
authors.initials: B
authors.lastname: Westra
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.
authors.forename: Jos P J
authors.initials: JP
authors.lastname: Wester
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.
authors.forename: Rob J
authors.initials: RJ
authors.lastname: Bosman
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.
authors.forename: Ilse
authors.initials: I
authors.lastname: van Stijn
authors.affiliation: Department of Clinical Chemistry, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Inez-Anne
authors.initials: IA
authors.lastname: Haagen
authors.affiliation: Department of Clinical Chemistry, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands ; Department of Clinical Chemistry, Reinier de Graaf Gasthuis, Delft, The Netherlands.
authors.forename: Ference J
authors.initials: FJ
authors.lastname: Loupatty
authors.affiliation: Department of Intensive Care Medicine, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: Rijkenberg
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood*; D016638:Critical Illness / Q000628:therapy; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000098:blood supply* / Q000473:pathology; D007511:Ischemia / Q000097:blood* / Q000175:diagnosis*; D019344:Lactic Acid / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; C493404:FABP2 protein, human; D050556:Fatty Acid-Binding Proteins; D019344:Lactic Acid; D003402:Creatine Kinase
keywords: ALAT; Bowel; Creatine kinase; Critically ill; D-lactate; I-FABP; Intestinal ischemia; L-lactate; LDH
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