Succoring the challenging acute mesenteric ischemia: Feasibility of lactate  dehydrogenase for evaluation of intestinal necrosis extension and mortality

Conde Monroy, Danny Michell; Giron Arango, Felipe; Rodríguez Moreno, Lina; Rey Chaves, Carlos Eduardo; Donoso-Samper, Andrea; Nassar, Ricardo; Isaza-Restrepo, Andres

doi:http://doi.org/10.1016/j.amsu.2022.104922

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Succoring the challenging acute mesenteric ischemia: Feasibility of lactate dehydrogenase for evaluation of intestinal necrosis extension and mortality

https://repository.urosario.edu.co/handle/10336/47049
http://doi.org/10.1016/j.amsu.2022.104922

Autores

Conde Monroy, Danny Michell

Giron Arango, Felipe

Rodríguez Moreno, Lina

Rey Chaves, Carlos Eduardo

Donoso-Samper, Andrea

Nassar, Ricardo

Isaza-Restrepo, Andres

Fecha

2022-08-20

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Resumen

Debido a su presentación clínica ambigua y la falta de marcadores diagnósticos tempranos, el lactato sérico se considera un biomarcador relevante para la duración de la necrosis intestinal y la predicción de mortalidad. Sin embargo, su asociación ha sido poco estudiada. Por lo tanto, evaluamos la relación entre los niveles séricos de lactato al ingreso, la extensión de la necrosis intestinal y la mortalidad en pacientes con isquemia mesentérica aguda. Métodos: Se realizó un estudio transversal retrospectivo con una base de datos prospectiva, que incluyó a pacientes mayores de 18 años con isquemia mesentérica que requirieron tratamiento quirúrgico entre enero de 2012 y diciembre de 2018. Describimos la asociación entre los niveles séricos de lactato al ingreso con la duración de la necrosis intestinal y la mortalidad en pacientes con isquemia mesentérica aguda. a. Results: 74 patients presented with acute mesenteric ischemia, 44 males and 30 females. Mean age was 73.5 ± 10.7 years old. Significant association between serum lactate admission levels and mortality was found (ROC cut value of 3.8 mmol/l, 81.0% sensibility and 76% specificity, LR+3.41 (95%CI 1.57, 7.40), LR- 0.25 (95%CI 0.13–0.45))(P.001). Nonetheless no statistically significant association was found between serum lactate admission levels and bowel necrosis length (ρ = 0.195,95%CI -0.046, − 0.436, P > .99). As post hoc analysis, a classification and regression tree on mortality was fitted. Conclusions: Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate admission levels can be considered as a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.

Abstract

Background: Acute mesenteric ischemia is a lethal challenging pathology for surgeons in the emergency department due to its ambiguous clinical presentation and lack of early diagnostic markers. Serum lactate is considered a relevant biomarker in terms of bowel necrosis length and mortality prediction. Nevertheless, its association has been poorly studied. Hence, we evaluated the relation between serum lactate admission levels, bowel necrosis extension, and mortality in patients with acute mesenteric ischemia. Methods: A Retrospective cross-sectional study with a prospective database was conducted, including patients over 18 years old with mesenteric ischemia that required surgical management between January 2012 and December 2018. We describe the association between serum lactate admission levels with bowel necrosis length and mortality in patients with acute mesenteric ischemia. Results: 74 patients presented with acute mesenteric ischemia, 44 males and 30 females. Mean age was 73.5 ± 10.7 years old. Significant association between serum lactate admission levels and mortality was found (ROC cut value of 3.8 mmol/l, 81.0% sensibility and 76% specificity, LR+3.41 (95%CI 1.57, 7.40), LR- 0.25 (95%CI 0.13–0.45))(P.001). Nonetheless no statistically significant association was found between serum lactate admission levels and bowel necrosis length (ρ = 0.195,95%CI -0.046, − 0.436, P > .99). As post hoc analysis, a classification and regression tree on mortality was fitted. Conclusions: Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate admission levels can be considered as a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.