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Observational Study
. 2014 Dec 2:14:111.
doi: 10.1186/1471-2253-14-111. eCollection 2014.

Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia

Peter H J van der Voort  1 , Berit Westra  2 , Jos P J Wester  2 , Rob J Bosman  2 , Ilse van Stijn  2 , Inez-Anne Haagen  3 , Ference J Loupatty  4 , Saskia Rijkenberg  2
Affiliations
Observational Study

Can serum L-lactate, D-lactate, creatine kinase and I-FABP be used as diagnostic markers in critically ill patients suspected for bowel ischemia

Peter H J van der Voort et al. BMC Anesthesiol. .

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.

Keywords: ALAT; Bowel; Creatine kinase; Critically ill; D-lactate; I-FABP; Intestinal ischemia; L-lactate; LDH.

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Figures

Figure 1
Figure 1
Flowchart of included patients.
Figure 2
Figure 2
Boxplots of I-FABP and D-lactate in patients with and without intestinal ischemia.
Figure 3
Figure 3
Boxplots of L-lactate, CK, LDH and ALAT in patients with and without intestinal ischemia.
Figure 4
Figure 4
ROC curve of L-lactate to detect intestinal ischemia.
See this image and copyright information in PMC

References

    1. Acosta S. Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg. 2010;23:4–8. doi: 10.1053/j.semvascsurg.2009.12.001. - DOI - PubMed
    1. Nilsson J, Hansson E, Andersson B. Intestinal ischemia after cardiac surgery: analysis of a large registry. J Cardiothorac Surg. 2013;8:156. doi: 10.1186/1749-8090-8-156. - DOI - PMC - PubMed
    1. Björck M, Wanhainen A. Nonocclusive mesenteric hypoperfusion syndromes: recognition and treatment. Semin Vasc Surg. 2010;23:54–64. doi: 10.1053/j.semvascsurg.2009.12.009. - DOI - PubMed
    1. Howard TJ, Plaskon LA, Wiebke EA, Wilcox MG, Madura JA. Non-occlusive mesenteric ischemia remains a diagnostic dilemma. Am J Surg. 1996;171:405–408. doi: 10.1016/S0002-9610(97)89619-5. - DOI - PubMed
    1. Demir IE, Ceyhan GO, Friess H. Beyond lactate: is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29:226–235. doi: 10.1159/000338086. - DOI - PubMed
Pre-publication history
    1. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2253/14/111/prepub

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