Abstract
BackgroundIntussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes.MethodsThe electronic medical records of our emergency department pediatric patients diagnosed with intussusception, between January 2015 and October 2018, were reviewed. An outcome was considered poor when intussusception recurred within 48 h of reduction or when surgical reduction was required due to air enema failure.ResultsA total of 249 patients were included in the study, including 39 who experienced intussusception recurrence and 11 who required surgical reductions; hence, 50 patients were included in the poor outcome group. The poor and good outcome groups showed significant differences in their respective blood gas analyses for pH (7.39 vs. 7.41, P = .001), lactic acid (1.70 vs. 1.30 mmol/L, P < .001), and bicarbonate (20.70 vs. 21.80 mmol/L, P = .036). Multivariable logistic regression analyses showed that pH and lactic acid levels were the two factors significantly associated with poor outcomes. When the lactic acid level cutoff values were ≥ 1.5, ≥2.0, ≥2.5, and ≥ 3.0 mmol/L, the positive predictive values for poor outcomes were 30.0, 34.6, 50.0, and 88.9%, respectively.ConclusionLactic acid levels affect outcomes in pediatric patients with intussusception; higher lactic acid levels are associated with higher positive predictive values for poor outcomes.
Highlights
Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels
249 patients were included in the analysis, after excluding patients with incomplete data, leading points (n = 5), or who had been transferred to other hospitals (n = 3)
Among these three possible risk factors, the multivariable logistic regression analysis indicated that only pH and lactic acid levels were significantly different between the two groups (Table 3)
Summary
Intussusception decreases blood flow to the bowel, and tissue hypoperfusion results in increased lactic acid levels. We aimed to determine whether lactic acid levels are associated with pediatric intussusception outcomes. Intussusception, an abdominal emergency, is one of the most frequent causes of bowel obstruction in the pediatric population [1, 2]. Its treatment involves reduction, using an air or barium enema, or, in some cases, surgical reduction [3, 4]. If intussusception is not relieved, the bowel vascular supply becomes compromised, causing intestinal ischemia progression and a risk of perforation. Elevated lactic acid levels occur secondary to tissue hypoperfusion/hypoxia or to causes unrelated to tissue hypoxia. Hypoperfusion-driven cases include all forms of shock, post-cardiac arrest, and regional ischemia [9]. Reversible or irreversible intestinal ischemia develops following intussusception, potentially causing
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