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

van der Voort PH, Westra B, Wester JP, Bosman RJ, van Stijn I, Haagen IA, Loupatty FJ, Rijkenberg S - BMC Anesthesiol (2014)

Bottom Line: 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).However, L-lactate and D-lactate levels were higher in patients with proven or likely ischemia and need further study just as I-FABP.

View Article: PubMed Central - PubMed

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.

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.

Show MeSH

Related in: MedlinePlus

Flowchart of included patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
getmorefigures.php?uid=PMC4384375&req=5

Fig1: Flowchart of included patients.

Mentions: The study was performed over a period of 24 months. In the study period 2988 patients were admitted to the ICU. 138 samples were collected. 18 samples were duplicate samples of the same patient and therefore excluded for analysis. Baseline characteristics of the 120 included patients are shown in Table 1. The most common diagnosis on admission (39%) in patients with proven intestinal ischemia was other surgery, which included intra-thoracic vascular and heart valve surgery.Figure 1 shows the flow chart for included patients. For 44 of the 120 included patients definite diagnostic studies were available. For the other 76 patients a definite diagnosis could not be made. For the 44 patients with a definite diagnosis, 23 patients (52%) had the diagnosis bowel ischemia confirmed by surgery (n = 20), colonoscopy (n = 2), CT scan (n = 1), autopsy (n = 3) and/or histopathological findings (n = 10). The other 21 patients (48%) underwent surgery (n = 17) and/or autopsy (n = 5) but did not have signs of intestinal ischemia.Table 1


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

van der Voort PH, Westra B, Wester JP, Bosman RJ, van Stijn I, Haagen IA, Loupatty FJ, Rijkenberg S - BMC Anesthesiol (2014)

Flowchart of included patients.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4384375&req=5

Fig1: Flowchart of included patients.
Mentions: The study was performed over a period of 24 months. In the study period 2988 patients were admitted to the ICU. 138 samples were collected. 18 samples were duplicate samples of the same patient and therefore excluded for analysis. Baseline characteristics of the 120 included patients are shown in Table 1. The most common diagnosis on admission (39%) in patients with proven intestinal ischemia was other surgery, which included intra-thoracic vascular and heart valve surgery.Figure 1 shows the flow chart for included patients. For 44 of the 120 included patients definite diagnostic studies were available. For the other 76 patients a definite diagnosis could not be made. For the 44 patients with a definite diagnosis, 23 patients (52%) had the diagnosis bowel ischemia confirmed by surgery (n = 20), colonoscopy (n = 2), CT scan (n = 1), autopsy (n = 3) and/or histopathological findings (n = 10). The other 21 patients (48%) underwent surgery (n = 17) and/or autopsy (n = 5) but did not have signs of intestinal ischemia.Table 1

Bottom Line: 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).However, L-lactate and D-lactate levels were higher in patients with proven or likely ischemia and need further study just as I-FABP.

View Article: PubMed Central - PubMed

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.

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.

Show MeSH
Related in: MedlinePlus