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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.

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Related in: MedlinePlus

ROC curve of L-lactate to detect intestinal ischemia.
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Fig4: ROC curve of L-lactate to detect intestinal ischemia.

Mentions: When all groups were taken into account, a statistical significant difference was found between groups (p = 0.001). However, between individual groups a statistical significant difference was present only in the comparison between ischemia likely and unlikely (p = 0.002). The median L-lactate levels in patients with proven and no ischemia were 3.5 mmol/L (2.2-8.4) and 2.6 mmol/L (1.7-3.9), respectively (p = 0.09). The combined groups proven and likely together compared to unlikely and no-ischemia together showed L-lactate levels of 3.9 (IQR 2.4-7.4) versus 1.9 (IQR 1.3-3.2); p = 0.001.We determined the best cut-off point to differentiate patients with proven ischemia and no intestinal ischemia by using the sum of maximum sensitivity and specificity. In a ROC-analysis (Figure 4) showed an area under curve of 0.65 (95%CI 0.49-0.81, p = 0.09). Using a cut-off point of 2.2 mmol/L the sensitivity was 78% and the specificity was 48%.Figure 4


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)

ROC curve of L-lactate to detect intestinal ischemia.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig4: ROC curve of L-lactate to detect intestinal ischemia.
Mentions: When all groups were taken into account, a statistical significant difference was found between groups (p = 0.001). However, between individual groups a statistical significant difference was present only in the comparison between ischemia likely and unlikely (p = 0.002). The median L-lactate levels in patients with proven and no ischemia were 3.5 mmol/L (2.2-8.4) and 2.6 mmol/L (1.7-3.9), respectively (p = 0.09). The combined groups proven and likely together compared to unlikely and no-ischemia together showed L-lactate levels of 3.9 (IQR 2.4-7.4) versus 1.9 (IQR 1.3-3.2); p = 0.001.We determined the best cut-off point to differentiate patients with proven ischemia and no intestinal ischemia by using the sum of maximum sensitivity and specificity. In a ROC-analysis (Figure 4) showed an area under curve of 0.65 (95%CI 0.49-0.81, p = 0.09). Using a cut-off point of 2.2 mmol/L the sensitivity was 78% and the specificity was 48%.Figure 4

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