The Value of Serial Serum Lactate Measurements in Predicting the Extent of Ischemic Bowel and Outcome of Patients Suffering Acute Mesenteric Ischemia

Abstract

BackgroundAcute mesenteric ischemia (AMI) is an emergency with a mortality rate up to 50 %. Detecting AMI continues to be a major challenge. This study assed the correlation of repeated preoperative serum lactate with bowel necrosis and to identify risk factors for a lethal outcome in patients with AMI. MethodsA retrospective study of 91 patients with clinically and pathologically confirmed AMI from January 2006 to December 2012 was performed. ResultsIn-hospital mortality rate was 42.9 %. Two hundred nine preoperative lactate measurements were analyzed (2.3±1.1 values per patient). Less than or equal to six hours prior to surgery, the mean serum lactate level was significantly higher (4.97±4.21 vs. 3.24±3.05 mmol/L, p = 0.006) and the mean pH significantly lower (7.28±0.12 vs. 7.37 ± 0.08, p = 0.001) compared to >6 h before surgery. Thirty-four patients had at least two lactate measurements within 24 h prior to surgery. In this subgroup, 17 patients (50 %) exhibited an increase, 17 patients (50 %) a decrease in lactate levels. Forward logistic regression analysis showed that length of necrotic bowel and the highest lactate value 24 h prior to surgery were independent risk factors for mortality (r2 = 0.329). ConclusionThe value of serial lactate and pH measurements to predict the length of necrotic bowel is very limited. Length of necrotic bowel and lactate values are independent risk factors for mortality.