Advertisement

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

  • A. Brillantino
  • F. Iacobellis
  • A. Renzi
  • R. Nasti
  • L. Saldamarco
  • M. Grillo
  • L. Romano
  • M. Castriconi
  • A. Cittadini
  • M. De Palma
  • M. Scaglione
  • N. Di Martino
  • R. Grassi
  • F. Paladino
Original Article

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.

Keywords

Intestinal infarction Bowel ischemia Mesenteric ischemia Ischemic colitis Lactate Arterial blood gas 

Abbreviations

AMI

Acute mesenteric ischemia

ABG

Arterial blood gas

CT

Computer tomography

Notes

Authors’ 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.

Compliance with ethical standards

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.

Research involving human participants and/or animals

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

Informed consent

All the patients gave informed written consent.

References

  1. 1.
    Ruotolo RA, Evans SR. Mesenteric ischemia in the elderly. Clin Geriatr Med. 1999;15:527–57.PubMedGoogle Scholar
  2. 2.
    Greenwald DA, Brandt LJ, Reinus JF. Ischemic bowel disease in the elderly. Gastroenterol Clin North Am. 2001;30:445–73.CrossRefPubMedGoogle Scholar
  3. 3.
    Reginelli A, Iacobellis F, Berritto D, Gagliardi G, Di Grezia G, Rossi M, Fonio P, Grassi R. Mesenteric ischemia: the importance of differential diagnosis for the surgeon. BMC Surg. 2013;13(Suppl 2):S51. doi: 10.1186/1471-2482-13-S2-S51.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Reginelli A, Genovese E, Cappabianca S, Iacobellis F, Berritto D, Fonio P, Coppolino F, Grassi R. Intestinal ischemia: US-CT findings correlations. Crit Ultrasound J. 2013;5(Suppl 1):S7. doi: 10.1186/2036-7902-5-S1-S7.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Matsumoto S, Sekine K, Funaoka H, Yamazaki M, Shimizu M, Hayashida K, Kitano M. Diagnostic performance of plasma biomarkers in patients with acute intestinal ischaemia. Br J Surg. 2014;101(3):232–8. doi: 10.1002/bjs.9331.CrossRefPubMedGoogle Scholar
  6. 6.
    Kozuch PL, Brandt LJ. Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther. 2005;21(3):201–15.CrossRefPubMedGoogle Scholar
  7. 7.
    Acosta S, Björck M. Modern treatment of acute mesenteric ischaemia. Br J Surg. 2014;101(1):e100–8. doi: 10.1002/bjs.933.CrossRefPubMedGoogle Scholar
  8. 8.
    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(3):226–35. doi: 10.1159/000338086.CrossRefPubMedGoogle Scholar
  9. 9.
    Lange H, Jackel R. Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg. 1994;160:381–4.PubMedGoogle Scholar
  10. 10.
    Lange H, Toivola A. Warning signals in acute abdominal disorders. Lactate is the best marker of mesenteric ischemia. Lakartidningen. 1997;94:1893–6 (in Swedish).PubMedGoogle Scholar
  11. 11.
    Akutsu K, Matsuda H, Sasaki H, Minatoya K, Ogino H, Kasai S, Tamori Y, Yokoyama N, Nonogi H, Takeshita S. A case of acute type B aortic dissection: limited role of laboratory testing for the diagnosis of mesenteric ischemia. Ann Thorac Cardiovasc Surg. 2007;13:360–4.PubMedGoogle Scholar
  12. 12.
    Acosta S, Block T, Bjornsson S, Resch T, Bjorck M, Nilsson T. Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion. J Emerg Med. 2012;42(6):635-41. doi: 10.1016/j.jemermed.2011.03.036 CrossRefPubMedGoogle Scholar
  13. 13.
    Nutz V, Sommer JH, Schultze-Petzold J. Hyperlactacidemia in intestinal ischemia. II. Experimental principles. Langenbecks Arch Chir. 1987;370:69–78 (in German).CrossRefPubMedGoogle Scholar
  14. 14.
    Murthy S, Hui-Qi Q, Sakai T, Depace DE, Fondacaro JD. Ischemia/reperfusion injury in the rat colon. Inflammation. 1997;21:173–90.CrossRefPubMedGoogle Scholar
  15. 15.
    Rendig SV, Chahal PS, Longhurst JC. Cardiovascular reflex responses to ischemia during occlusion of celiac and/or superior mesenteric arteries. Am J Physiol. 1997;272:H791–6.PubMedGoogle Scholar
  16. 16.
    Schlichting E, Lyberg T. Monitoring of tissue oxygenation in shock: an experimental study in pigs. Crit Care Med. 1995;23:1703–10.CrossRefPubMedGoogle Scholar
  17. 17.
    Ljungdahl M, Rasmussen I, Raab Y, Hillered L, Haglund U. Small intestinal mucosal pH and lactate production during experimental ischemia–reperfusion and fecal peritonitis in pigs. Shock. 1997;7:131–8.CrossRefPubMedGoogle Scholar
  18. 18.
    Rasmussen I, Haglund U. Early gut ischemia in experimental fecal peritonitis. Circ Shock. 1992;38:22–8.PubMedGoogle Scholar
  19. 19.
    Heino A, Hartikainen J, Merasto ME, Alhava E, Takala J. Systemic and regional pCO2 gradients as markers of intestinal ischaemia. Intensive Care Med. 1998;24:599–604.CrossRefPubMedGoogle Scholar
  20. 20.
    Acosta S, Nilsson TK, Malina J, Malina M. l-Lactate after embolization of the superior mesenteric artery. J Surg Res. 2007;143:320–8.CrossRefPubMedGoogle Scholar
  21. 21.
    Kurimoto Y, Kawaharada N, Ito T, Morikawa M, Higami T, Asai Y. An experimental evaluation of the lactate concentration following mesenteric ischemia. Surg Today. 2008;38:926–30.CrossRefPubMedGoogle Scholar
  22. 22.
    Murray MJ, Barbose JJ, Cobb CF. Serum d(−)-lactate levels as a predictor of acute intestinal ischemia in a rat model. J Surg Res. 1993;54:507–9.CrossRefPubMedGoogle Scholar
  23. 23.
    Murray MJ, Gonze MD, Nowak LR, Cobb CF. Serum d(−)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg. 1994;167:575–8.CrossRefPubMedGoogle Scholar
  24. 24.
    Gearhart SL, Delaney CP, Senagore AJ, Banbury MK, Remzi FH, Kiran RP, Fazio VW. Prospective assessment of the predictive value of alpha-glutathione S-transferase for intestinal ischemia. Am Surg. 2003;69:324–9 (Discussion 329).PubMedGoogle Scholar
  25. 25.
    Sun XQ, Fu XB, Zhang R, Lu Y, Deng Q, Jiang XG, Sheng XY. Relationship between plasma d(−)-lactate and intestinal damage after severe injuries in rats. World J Gastroenterol. 2001;7:555–8.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Evennett NJ, Petrov MS, Mittal A, Windsor JA. Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. World J Surg. 2009;33:1374–83.CrossRefPubMedGoogle Scholar
  27. 27.
    Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med. 1992;20:80–93.CrossRefPubMedGoogle Scholar
  28. 28.
    Berritto D, Iacobellis F, Somma F, Corona M, Faggian A, Iacomino A, Feragalli B, Saba L, La Porta M, Grassi R. 7T mMR in the assessment of acute arterial mesenteric ischemia in a rat model. J Biol Regul Homeost Agents. 2013;27(3):771–9.PubMedGoogle Scholar
  29. 29.
    Somma F, Berritto D, Iacobellis F, Landi N, Cavaliere C, Corona M, Russo S, Di Mizio R, Rotondo A, Grassi R. 7T μMRI of mesenteric venous ischemia in a rat model: timing of the appearance of findings. Magn Reson Imaging. 2013;31(3):408–13. doi: 10.1016/j.mri.2012.08.003.CrossRefPubMedGoogle Scholar
  30. 30.
    Saba L, Berritto D, Iacobellis F, Scaglione M, Castaldo S, Cozzolino S, Mazzei MA, Di Mizio V, Grassi R. Acute arterial mesenteric ischemia and reperfusion: macroscopic and MRI findings, preliminary report. World J Gastroenterol. 2013;19(40):6825–33. doi: 10.3748/wjg.v19.i40.6825.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Mazzei MA, Guerrini S, Cioffi Squitieri N, Vindigni C, Imbriaco G, Gentili F, Berritto D, Mazzei FG, Grassi R, Volterrani L. Reperfusion in non-occlusive mesenteric ischaemia (NOMI): effectiveness of CT in an emergency setting. Br J Radiol. 1061;2016(89):20150956. doi: 10.1259/bjr.20150956.Google Scholar
  32. 32.
    Iacobellis F, Berritto D, Fleischmann D, Gagliardi G, Brillantino A, Mazzei MA, Grassi R. CT findings in acute, subacute, and chronic ischemic colitis: suggestions for diagnosis. Biomed Res Int. 2014;2014:895248. doi: 10.1155/2014/895248.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Berritto D, Iacobellis F, Mazzei MA, Volterrani L, Guglielmi G, Brunese L, Grassi R. MDCT in ischaemic colitis: how to define the aetiology and acute, subacute and chronic phase of damage in the emergency setting. Br J Radiol. 1061;2016(89):20150821. doi: 10.1259/bjr.20150821.Google Scholar
  34. 34.
    Iacobellis F, Berritto D, Somma F, Cavaliere C, Corona M, Cozzolino S, Fulciniti F, Cappabianca S, Rotondo A, Grassi R. Magnetic resonance imaging: a new tool for diagnosis of acute ischemic colitis? World J Gastroenterol. 2012;18(13):1496–501. doi: 10.3748/wjg.v18.i13.1496.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Iacobellis F, Berritto D, Belfiore MP, Di Lanno I, Maiorino M, Saba L, Grassi R. Meaning of free intraperitoneal fluid in small-bowel obstruction: preliminary results using high-frequency microsonography in a rat model. J Ultrasound Med. 2014;33(5):887–93. doi: 10.7863/ultra.33.5.887.CrossRefPubMedGoogle Scholar
  36. 36.
    Berritto D, Iacobellis F, Belfiore MP, Rossi C, Saba L, Grassi R. Early MRI findings of small bowel obstruction: an experimental study in rats. Radiol Med. 2014;119(6):377–83. doi: 10.1007/s11547-013-0370-z.CrossRefPubMedGoogle Scholar
  37. 37.
    Kadakia SC. d-Lactic acidosis in a patient with jejunoileal bypass. J Clin Gastroenterol. 1995;20:154–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Forsyth RJ, Moulden A, Hull D. d-Lactate associated encephalopathy in short bowel syndrome: management with long-term non-absorbable oral antimicrobials. Clin Nutr. 1991;10:352–5.CrossRefPubMedGoogle Scholar
  39. 39.
    Zhang DL, Jiang ZW, Jiang J, Cao B, Li JS. d Lactic acidosis secondary to short bowel syndrome. Postgrad Med J. 2003;79:110–2.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Stacpoole PW, Wright EC, Baumgartner TG, Bersin RM, Buchalter S, Curry SH, et al. Natural history and course of acquired lactic acidosis in adults. Am J Med. 1994;97:47–54.CrossRefPubMedGoogle Scholar
  41. 41.
    Jansen TC, van Bommel J, Bakker J. Blood lactate monitoring in critically ill patients: a systematic health technology assessment. Crit Care Med. 2009;37(10):2827–39.PubMedGoogle Scholar
  42. 42.
    Kruse O, Grunnet N, Barfod C. Blood lactate as a predictor for in-hospital mortality in patients admitted acutely to hospital: a systematic review. Scand J Trauma Resusc Emerg Med. 2011;19:74.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Benzon HT, Toleikis JR, Meagher LL, Shapiro BA, Ts’ao CH, Avram MJ. Changes in venous blood lactate, venous blood gases, and somatosensory evoked potentials after tourniquet application. Anesthesiology. 1988;69(5):677–82.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • A. Brillantino
    • 1
  • F. Iacobellis
    • 2
  • A. Renzi
    • 3
  • R. Nasti
    • 1
  • L. Saldamarco
    • 1
  • M. Grillo
    • 4
  • L. Romano
    • 5
  • M. Castriconi
    • 4
  • A. Cittadini
    • 6
  • M. De Palma
    • 4
  • M. Scaglione
    • 7
    • 8
  • N. Di Martino
    • 9
  • R. Grassi
    • 2
  • F. Paladino
    • 1
  1. 1.Emergency Department “A. Cardarelli” HospitalNaplesItaly
  2. 2.Department of RadiologySecond University of NaplesNaplesItaly
  3. 3.Pelvic Care Center“Villa delle Querce” HospitalNaplesItaly
  4. 4.Department of Surgery“A. Cardarelli” HospitalNaplesItaly
  5. 5.Department of Radiology“A. Cardarelli” HospitalNaplesItaly
  6. 6.Department of Medical Translational SciencesUniversity “Federico II”NaplesItaly
  7. 7.Department of Diagnostic Imaging“Pineta Grande” HospitalCastel VolturnoItaly
  8. 8.Department of RadiologyUniversity Hospitals of North MidlandsStoke-on-TrentUK
  9. 9.Department of SurgerySecond University of NaplesNaplesItaly

Personalised recommendations