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Diagnostic value of arterial blood gas lactate concentration in the different forms of mesenteric ischemia

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The role of serum lactate measurement in patients with intestinal ischemia still remains unclear. The aim of this study was to prospectively evaluate the diagnostic performance of arterial blood gas lactate concentrations in the patients with acute mesenteric ischemia and its different forms.

Methods

All the patients reporting abdominal pain associated with risk factors for mesenteric ischemia underwent arterial blood gas and contrast enhanced abdominal computer tomography (CT).

Results

At CT, 201 patients (70.7%) showed a nonischemic disease (group 1) and 83 patients (29.2%) showed findings of mesenteric ischemia. Out of these, 35 patients (42.1%) showed bowel ischemia secondary to non vascular causes (group 2) and 48 (57.8%) had a vascular intestinal ischemia (group 3). Out of these, 20 showed small bowel arterial occlusion (group 3a), 13 a small bowel nonocclusive ischemia (group 3b), 7 a venous small bowel occlusion (group 3c) and 8 showed isolated colonic ischemia (group 3d). The median lactate serum level was significantly higher in patients with vascular ischemia if compared with patients with nonischemic disease and secondary mesenteric ischemia (p < 0.0001; Kruskal–Wallis test). The areas under ROC curves for the lactate serum levels in the groups 2, 3, 3a, 3b, 3c and 3d were, respectively, 0.61, 0.85, 0.93, 0.93, 0.68 and 0.67.

Conclusions

Arterial blood gas lactate levels seem to show good diagnostic accuracy in diagnosing small bowel arterial and nonocclusive ischemia and poor accuracy in diagnosing secondary mesenteric ischemia, small bowel venous ischemia and ischemic colitis.

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Abbreviations

AMI:

Acute mesenteric ischemia

ABG:

Arterial blood gas

CT:

Computer tomography

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Author information

Author notes

  1. A. Brillantino and F. Iacobellis contributed equally to this work.

Authors and Affiliations

  1. Emergency Department “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    A. Brillantino, R. Nasti, L. Saldamarco & F. Paladino

  2. Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

    F. Iacobellis & R. Grassi

  3. Pelvic Care Center, “Villa delle Querce” Hospital, Via B. Caracciolo 48, Naples, Italy

    A. Renzi

  4. Department of Surgery, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    M. Grillo, M. Castriconi & M. De Palma

  5. Department of Radiology, “A. Cardarelli” Hospital, Via A. Cardarelli 9, 80131, Naples, Italy

    L. Romano

  6. Department of Medical Translational Sciences, University “Federico II”, Via Pansini 5, 80131, Naples, Italy

    A. Cittadini

  7. Department of Diagnostic Imaging, “Pineta Grande” Hospital, Via Domitiana Km 30.000, 81030, Castel Volturno, CE, Italy

    M. Scaglione

  8. Department of Radiology, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK

    M. Scaglione

  9. Department of Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy

    N. Di Martino

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Contributions

AB and FI participated in the conception of study, carried out the statistical analysis and drafted the manuscript. AR, RN and LS participated in the acquisition data and helped in drafting the manuscript. MG, MC and MDP participated in the data acquisition and in the study design. LR, MS and RG contributed in data interpretation. AC, NDM and FP participated in study design and coordination and reviewed the final version of the manuscript.

Corresponding author

Correspondence to A. Brillantino.

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Conflict of interest

Antonio Brillantino, Francesca Iacobellis, Adolfo Renzi, Rodolfo Nasti, Lavinia Saldamarco, Maurizio Grillo, Luigia Romano, Maurizio Castriconi, Antonio Cittadini, Maurizio De Palma, Mariano Scaglione, Natale Di Martino, Roberto Grassi and Fiorella Paladino declare that they have no conflict of interest regarding the publication of this article.

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The study involves Human Participants; the ethical committee of our Institution approved the study protocol.

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Brillantino, A., Iacobellis, F., Renzi, A. et al. Diagnostic value of arterial blood gas lactate concentration in the different forms of mesenteric ischemia. Eur J Trauma Emerg Surg 44, 265–272 (2018). https://doi.org/10.1007/s00068-017-0805-7

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  • DOI: https://doi.org/10.1007/s00068-017-0805-7

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