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Are Mortality and Morbidity Predictable in Acute Mesenteric Ischemia? The Importance of Serum Lactate, Lactate Dehydrogenase, and Blood Urea Nitrogen Levels

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Abstract

Acute mesenteric ischemia (AMI) is a rare cause of acute abdomen in which blood flow in the intestines is disrupted for any reason. In this study, we aimed to determine the predicting effects of demographic and clinical data, particularly laboratory parameters including lactate (Lac), lactate dehydrogenase (LDH), and blood urea nitrogen (BUN) in the preoperative period in AMI. The patients who were hospitalized and treated with the diagnosis of AMI were included in the study. Demographic, clinical, laboratory, and surgery-related parameters of the patients were analyzed retrospectively. The mean age of the patients included in the study was 69.1 ± 9.3 (54–89 years). The mortality rate among patients was 45.8%. The preoperative serum LDH (p < 0.001) and Lac (p < 0.001) levels were significantly higher in the patient group with mortality than in the patient group without mortality. Preoperative Lac (AUC = 0.947) and LDH (AUC = 0.962) levels were found to be a strong predictor of mortality. However, the preoperative BUN levels alone were not a sufficient predictor of mortality (AUC = 0.643, p = 0.094). A preoperative Lac level above 3.76 mmol/l was a predictor of mortality with 100% sensitivity and 80.8% specificity. A preoperative LDH level above 391 IU/l was a predictor of mortality with 90.9% sensitivity and 88.5% specificity. A preoperative BUN level above 66 mg/dl was a predictor of mortality with 40.9% sensitivity and 100% specificity. Early evaluation of serum Lac, LDH, and BUN levels as well as simultaneous monitoring with treatment may be a significant predictive parameter in the survival and reduction of complications in AMI.

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References

  1. Clair DG, Beach JM (2016) Mesenteric Ischemia. N Engl J Med 374(10):959–968. https://doi.org/10.1056/NEJMra1503884

    Article  CAS  PubMed  Google Scholar 

  2. Horton KM, Fishman EK (2010) CT angiography of the mesenteric circulation. Radiol Clin North Am 48(2):331–45. https://doi.org/10.1016/j.rcl.2010.02.004

    Article  PubMed  Google Scholar 

  3. Bala M, Kashuk J, Moore EE, Kluger Y, Biffl W, Gomes CA, Ben-Ishay O, Rubinstein C, Balogh ZJ, Civil I, Coccolini F, Leppaniemi A, Peitzman A, Ansaloni L, Sugrue M, Sartelli M, Di Saverio S, Fraga GP, Catena F (2017) Acute mesenteric ischemia: guidelines of the World Society of Emergency Surgery. World J Emerg Surg 12:38. https://doi.org/10.1186/s13017-017-0150-5

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nuzzo A, Guedj K, Curac S, Hercend C, Bendavid C, Gault N, Tran-Dinh A, Ronot M, Nicoletti A, Bouhnik Y, Castier Y, Corcos O, Peoc’h K, SURVI (Structure d’URgencesVasculairesIntestinales) Research Group (French Intestinal Stroke Center) (2021) Accuracy of citrulline, I-FABP and D-lactate in the diagnosis of acute mesenteric ischemia. Sci Rep 11(1):18929. https://doi.org/10.1038/s41598-021-98012-w

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Grotelüschen R, Bergmann W, Welte MN, Reeh M, Izbicki JR, Bachmann K (2019) What predicts the outcome in patients with intestinal ischemia? A single center experience. J Visc Surg 156(5):405–411. https://doi.org/10.1016/j.jviscsurg.2019.01.007

    Article  PubMed  Google Scholar 

  6. Kerzmann A, Haumann A, Boesmans E, Detry O, Defraigne JO (2018) L’ischémie mésentérique aiguë [Acute mesenteric ischemia]. Rev Med Liege 73(5–6):300–303

    CAS  PubMed  Google Scholar 

  7. Yıldırım D, Hut A, Tatar C, Dönmez T, Akıncı M, Toptaş M (2017) Prognostic factors in patients with acute mesenteric ischemia. Turk J Surg 33(2):104–109. https://doi.org/10.5152/UCD.2016.3534

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kärkkäinen JM (2021) Acute mesenteric ischemia: a challenge for the acute care surgeon. Scand J Surg 110(2):150–158. https://doi.org/10.1177/14574969211007590

    Article  PubMed  PubMed Central  Google Scholar 

  9. Acosta S, Kärkkäinen J (2019) Open abdomen in acute mesenteric ischemia. Anaesthesiol Intensive Ther 51(2):159–162. https://doi.org/10.5114/ait.2019.86280

    Article  PubMed  Google Scholar 

  10. Destek S, Yabacı A, Abik YN, Gül VO, Değer KC (2020) Predictive and prognostic value of L-lactate, D-dimer, leukocyte, C-reactive protein and neutrophil/lymphocyte ratio in patients with acute mesenteric ischemia. Ulus Travma Acil Cerrahi Derg 26(1):86–94

    PubMed  Google Scholar 

  11. Martini V, Lederer AK, Fink J, Chikhladze S, Utzolino S, Fichtner-Feigl S, Kousoulas L (2022) Clinical characteristics and outcome of patients with acute mesenteric ischemia: a retrospective cohort analysis. Langenbecks Arch Surg 407(3):1225–1232. https://doi.org/10.1007/s00423-021-02423-2

    Article  PubMed  PubMed Central  Google Scholar 

  12. Aliosmanoglu I, Gul M, Kapan M, Arikanoglu Z, Taskesen F, Basol O, Aldemir M (2013) Risk factors effecting mortality in acute mesenteric ischemia and mortality rates: a single center experience. Int Surg 98(1):76–81. https://doi.org/10.9738/CC112.1

    Article  PubMed  PubMed Central  Google Scholar 

  13. Weledji EP, Ngowe MN (2013) The challenge of intra-abdominal sepsis. Int J Surg 11(4):290–295. https://doi.org/10.1016/j.ijsu.2013.02.021

    Article  PubMed  Google Scholar 

  14. Maulini M, Yan DJ, Buchs N, Nendaz M (2020) Lactate et ischémie mésentérique aiguë : utilité diagnostique [Lactate and acute mesenteric ischemia: diagnostic value]. Rev Med Suisse 16(711):1974–1979

    PubMed  Google Scholar 

  15. Otto CC, Czigany Z, Heise D, Bruners P, Kotelis D, Lang SA, Ulmer TF, Neumann UP, Klink C, Bednarsch J (2022) Prognostic factors for mortality in acute mesenteric ischemia. J Clin Med 11(13):3619. https://doi.org/10.3390/jcm11133619

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Cakir M, Yildirim D, Sarac F, Donmez T, Mirapoglu S, Hut A, Erozgen F, Ozer OF, Gecer MO, Tigrel LZ, Tas O (2019) In the experimental model of acute mesenteric ischemia, the correlation of blood diagnostic parameters with the duration of ischemia and their effects on choice of treatment. J Invest Surg 32(6):507–514. https://doi.org/10.1080/08941939.2018.1437486

    Article  PubMed  Google Scholar 

  17. Caluwaerts M, Castanares-Zapatero D, Laterre PF, Hantson P (2019) Prognostic factors of acute mesenteric ischemia in ICU patients. BMC Gastroenterol 19(1):80. https://doi.org/10.1186/s12876-019-0999-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Matthaei H, Klein A, Branchi V, Kalff JC, Koscielny A (2019) Acute mesenteric ischemia (AMI): absence of renal insufficiency and performance of early bowel resection may indicate improved outcomes. Int J Colorectal Dis 34(10):1781–1790. https://doi.org/10.1007/s00384-019-03388-x

    Article  PubMed  Google Scholar 

  19. Acosta-Merida MA, Marchena-Gomez J, Hemmersbach-Miller M, Roque-Castellano C, Hernandez-Romero JM (2006) Identification of risk factors for perioperative mortality in acute mesenteric ischemia. World J Surg 30(8):1579–1585. https://doi.org/10.1007/s00268-005-0560-5

    Article  PubMed  Google Scholar 

  20. Liu D, Ye Y, Xie Q, Yin M, Yang X, Liang B, Wang S (2017) Predictive factors of intestinal necrosis in acute mesenteric vascular occlusive diseases. Zhonghua Wei Chang Wai Ke Za Zhi 20(7):787–791

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Keçiören, Ankara, 06010, Turkey

    Burak Uçaner, Mehmet Zeki Buldanlı, Mehmet Sabri Çiftçi, Şebnem Çimen & Oğuz Hançerlioğulları

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  1. Burak Uçaner
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  2. Mehmet Zeki Buldanlı
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  3. Mehmet Sabri Çiftçi
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Contributions

Burak Uçaner: study conception and design, acquisition of data, analysis and interpretation of data, drafting of manuscript, and critical revision. Mehmet Zeki Buldanlı: study conception and design, acquisition of data, and critical revision. Mehmet Sabri Çiftçi: study conception and design, acquisition of data. Şebnem Çimen: study conception and design, acquisition of data. Oğuz Hançerlioğulları: analysis and interpretation of data and drafting of manuscript.

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Correspondence to Burak Uçaner.

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This study was approved by the University of Health Sciences Gülhane Training and Research Hospital Clinical Researches Ethics Committee, Ankara, Turkey (Date: 14.09.2022 Decision No:2022/119).

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The authors declare no competing interests.

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Uçaner, B., Buldanlı, M.Z., Çiftçi, M.S. et al. Are Mortality and Morbidity Predictable in Acute Mesenteric Ischemia? The Importance of Serum Lactate, Lactate Dehydrogenase, and Blood Urea Nitrogen Levels. Indian J Surg 85, 1191–1197 (2023). https://doi.org/10.1007/s12262-023-03719-x

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