The place of D-dimer and L-lactate levels in the early diagnosis of acute mesenteric ischemia

IntroductionThe aim of this randomized controlled experimental study was to evaluate the efficacy of potassium, pH and D-dimer levels in blood, as well as potassium and pH levels in peritoneal lavage fluid, in the early diagnosis of acute mesenteric ischemia.Material and methodsThis study was conducted at the Istanbul University Center of Experimental Medicine after having received approval from the Istanbul University animal testing ethics committee. Male albino Wistar rats (n = 24; 250 to 350 g) were divided into two control groups and two ischemic groups. Levels of potassium, pH, and D-dimer in blood and levels of potassium and pH in peritoneal lavage fluid were analyzed for 1 h and 2 h after the induced acute mesenteric ischemia procedure. The degree of ischemic injury was determined using the histopathological damage score in tissue samples taken from the terminal ileum.ResultsIschemic groups had statistically significant differences in potassium and pH in blood and peritoneal lavage fluid compared to non-ischemic groups (p < 0.05). There was no significant difference between control and ischemic groups in terms of D-dimer and histologic grading results after 1 h (p = 0.132, p = 0.475 respectively), while there was a significant difference between control and ischemic groups after 2 h (p < 0.05).ConclusionsThe levels of potassium, pH, and D-dimer could be useful in daily practice for the early diagnosis of acute mesenteric ischemia.

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Fibrinopeptide-A and fibrinopeptide-B may help to D-dimer as early diagnosis markers for acute mesenteric ischemia

Turkish Journal of Biochemistry ◽

10.1515/tjb-2018-0301 ◽

2019 ◽

Vol 44 (5) ◽

pp. 654-660

Author(s):

Murat Cikot ◽

Eyup Gemici ◽

Nilgun Isiksacan ◽

Osman Kones ◽

Pinar Kasapoglu ◽

...

Keyword(s):

Early Diagnosis ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Control Group ◽

Albino Rats ◽

Fibrinopeptide A ◽

Mortality And Morbidity ◽

Ischemia Group ◽

Wistar Albino Rats ◽

D Dimer

Abstract Background The aim of this study was to investigate the importance of fibrinopeptide-A and fibrinopeptide-B, which occur during the formation of D-dimer, the most commonly used laboratory parameter, in the early diagnosis of acute mesenteric ischemia (AMI). Materials and methods This experimental study was performed in 30 male pathogen-free Wistar albino rats. The experimental animals were divided into 3 equal groups: Control group (n = 10), Sham group (n = 10) and Ischemia group (n = 10). Blood samples were taken 0, 1, 3, and 6 h after the simulation of mesenteric ischemia. Results Fibrinopeptide-A and fibrinopeptide-B levels increased significantly in the first 6 h in the ischemic group, similar to the increase in D-dimer levels. The statistical change between 0, 1, 3 and 6 h was more significant for fibrinopeptide-A and fibrinopeptide-B. Conclusion Fibrinopeptide-A and fibrinopeptide-B may be markers that can be used for early diagnosis of mesenteric ischemia, early diagnosis is highly important for decreasing mortality and morbidity.

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Mean Platelet Volume: Is It a Predictive Parameter in Diagnosis of Acute Mesenteric Ischemia?

International Surgery ◽

10.9738/intsurg-d-14-00268.1 ◽

2015 ◽

Vol 100 (5) ◽

pp. 962-965 ◽

Cited By ~ 3

Author(s):

Ahmet Türkoğlu ◽

Mesut Gül ◽

Abdullah Oğuz ◽

Zübeyir Bozdağ ◽

Burak Veli Ülger ◽

...

Keyword(s):

Early Diagnosis ◽

Mean Platelet Volume ◽

Mesenteric Ischemia ◽

Area Under The Curve ◽

Acute Mesenteric Ischemia ◽

The Elderly ◽

Control Group ◽

Characteristic Analysis ◽

Platelet Volume ◽

Cell Counts

Our objective for this study was to discuss the usability of mean platelet volume, which is associated with numerous vascular pathologies, in the early diagnosis of acute mesenteric ischemia. Acute mesenteric ischemia is an uncommon, life-threatening clinical condition mostly seen in the elderly. Early diagnosis of acute mesenteric ischemia and correction of blood circulation before necrosis occurs are important factors affecting prognosis. A total of 95 patients who underwent emergency surgery for acute mesenteric ischemia and 90 healthy volunteers as control group were included in this study. Age, gender, hemoglobin values, white blood cell counts, mean platelet volume, and platelet counts are recorded for evaluation. The mean platelet volume values were significantly higher in patients with acute mesenteric ischemia than in the controls (9.4 ± 1.1 fL and 7.4 ± 1.4 fL, respectively; P < 0.001). Receiver-operating characteristic analysis demonstrated a cutoff value of mean platelet volume as 8.1 fL (area under the curve, 0.862), a sensitivity of 83.2%, and a specificity of 80%. As a result, in the patients who are admitted to the hospital with acute nonspecific abdominal pain and suspected of having acute mesenteric ischemia, high mean platelet volume values in routine hemograms support the diagnosis of acute mesenteric ischemia.

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PP-019 The Effect of Serum, Intestinal and Peritoneal Visfatin Levels on Early Diagnosis of Acute Mesenteric Ischemia

The American Journal of Cardiology ◽

10.1016/j.amjcard.2015.01.375 ◽

2015 ◽

Vol 115 ◽

pp. S103-S104

Author(s):

Alper Uçak ◽

Veysel Temizkan ◽

Hüseyin Şen ◽

Erman Caner Bulut ◽

Murat Fatih Can ◽

...

Keyword(s):

Early Diagnosis ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia

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OUR SURGICAL EXPERIENCE IN ACUTE MESENTERIC ISCHEMIA- VARIOUS PATHOPHYSIOLGICAL TYPES – A CASE SERIES

10.36106/gjra/2000940 ◽

2021 ◽

pp. 25-29

Author(s):

B. Santhi ◽

A. Ramprasath ◽

R. Saradha

Keyword(s):

Abdominal Pain ◽

Early Diagnosis ◽

Elderly Patients ◽

Mesenteric Ischemia ◽

Hospital Admissions ◽

Case Series ◽

Arterial Occlusion ◽

Acute Mesenteric Ischemia ◽

Delayed Presentation ◽

Surgical Critical Care

BACKGROUND: Mesenteric ischemia is a frequently lethal condition resulting from critically reduced perfusion to the gastrointestinal tract. It accounts for 1-2% of hospital admissions for abdominal pain. Mortality due to mesenteric ischemia ranges from 24% to 96% with an average of 69%. AIM: The aim of this case series is to outline the clinical presentation and challenges in diagnosis of acute mesenteric ischemia and emphasize the importance of early diagnosis and intervention in reducing the mortality and morbidity. This article presents a series of 4 cases of the 3 major types of acute mesenteric ischemia – 2 cases of Acute Mesenteric Arterial Thrombosis(AMAT), one case of Acute Mesenteric Arterial Embolism(AMAE) and one case of Mesenteric Venous Thrombosis(MVT). MATERIALS AND METHODS: A total number of 4 patients who had undergone emergency laparotomy for acute mesenteric ischemia during the month of December 2020 in the Department of General Surgery, Government Kilpauk Medical College were studied. All 4 cases have been analysed during this study period of one month and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. Out of 4 cases, 3 were cases of Superior Mesenteric Arterial Occlusion due to thrombus and emboli and 1 was a case of Superior Mesenteric Vein Occlusion by thrombus. All 4 were male patients. All 4 patients presented with sudden onset of abdominal pain with or without vomiting. Abdominal distension, constipation and clinical features suggestive of bowel gangrene was not seen in all cases. Out of 4 cases, 2 cases were diagnosed early and taken up for immediate surgery and had a better outcome postoperatively with shorter hospital stay. Denitive diagnosis could not be made at time of admission for one case and was taken up for surgery late after the general condition of the patient deteriorated and extensive gangrene of the small bowel was seen during surgery. One case succumbed to septic shock after surgery following delayed presentation. This case series attempts to highlight that the key to successful management in acute mesenteric ischemia is a high index of suspicion leading to early diagnosis, aggressive resuscitation and early mesenteric revascularization. CONCLUSION: Despite the remarkable advances in in vascular surgical technique, vascular imaging, percutaneous intervention and surgical critical care, mesenteric ischemia remains a complex and often disheartening disease. Acute mesenteric ischemia is a life threatening vascular emergency that requires a high degree of clinical suspicion and early intervention to avoid a poor outcome. As Acute Mesenteric Ischemia often affects elderly patients, we have to consider the possibility of acute mesenteric ischemia in all elderly patients presenting with abdominal pain that is out of proportion to the ndings on physical examination

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Predictive factors of intestinal necrosis in acute mesenteric ischemia

Open Medicine ◽

10.1515/med-2019-0104 ◽

2019 ◽

Vol 14 (1) ◽

pp. 883-889 ◽

Cited By ~ 1

Author(s):

Alfonso Canfora ◽

Antonio Ferronetti ◽

Gianpaolo Marte ◽

Vittorio Di Maio ◽

Claudio Mauriello ◽

...

Keyword(s):

Multivariate Analysis ◽

Organ Failure ◽

Predictive Factors ◽

Mesenteric Ischemia ◽

Disease Risk ◽

Acute Mesenteric Ischemia ◽

Serum Lactate ◽

Intestinal Necrosis ◽

Ct Findings ◽

Lactate Levels

AbstractObjectivesAcute mesenteric ischemia (AMI) is a gastrointestinal and vascular emergency in which the detection of patients requiring intestinal resection is mandatory.MethodsRegistered data of 55 consecutive patients admitted to our center between January 2010 and December 2016 that underwent an explorative laparotomy for a suspected diagnosis of irreversible transmural intestinal necrosis (ITIN) were analyzed. Demographic, clinical, laboratory and CT findings were statistically analyzed in order to search predictive factors of ITIN and their correlation to its clinical spectre.ResultsTobacco use was the most statistically significant (p<0.01) cardiovascular disease risk factor involved in ITIN. Among lab tests, Serum lactate levels ˃ 2mmol/L resulted in a statistically significant association with ITIN (p=0.0001). Organ failure (defined as Marshall score> 2) and the three main CT findings (decreased bowel wall enhancement, bowel loop dilation and demonstrated vessel occlusion) were strongly associated with ITIN (p values: 0.001, 0.007, 0.0013, 0.0005). Only serum lactate levels>2 mmol/L resulted as statistically significant as predictive factors of ITIN in multivariate analysis using logistic regression (OR 49.66 and p-value 0.0021).ConclusionOur univariate and multivariate analysis identified multiple factors (Serum lactate levels ˃ 2mmol/L, Organ failure, CT signs) that could suggest patients that require a surgical approach for ITIN.

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Predictive and Prognostic Value of L-lactate, D-dimer, Leukocyte, C-Reactive Protein and Neutrophil/Lymphocyte Ratio in Patients with Acute Mesenteric Ischemia

Turkish Journal of Trauma and Emergency Surgery ◽

10.14744/tjtes.2019.61580 ◽

2020 ◽

Author(s):

Sabahattin Destek

Keyword(s):

Prognostic Value ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

C Reactive Protein ◽

Neutrophil Lymphocyte Ratio ◽

Lymphocyte Ratio ◽

Reactive Protein ◽

Predictive And Prognostic Value ◽

D Dimer

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Serum Lactate and Acute Mesenteric Ischemia: An Observational, Controlled Multicenter Study

10.21203/rs.3.rs-573044/v1 ◽

2021 ◽

Author(s):

Olivier Collange ◽

Marc LOPEZ ◽

Anne LEJAY ◽

Patrick PESSAUX ◽

Alexandre OUATTARA ◽

...

Keyword(s):

Multicenter Study ◽

Mesenteric Ischemia ◽

Acute Mesenteric Ischemia ◽

Serum Lactate ◽

Control Group ◽

Adult Intensive Care Unit ◽

Diagnosis And Prognosis ◽

Significant Difference ◽

Lactate Levels ◽

Matching Criteria

Abstract Purpose Early diagnosis of acute mesenteric ischemia (AMI) is key to survival but remains extremely difficult, as the symptoms are vague and non-specific. Although international guidelines recommend that serum lactate is not used for AMI diagnosis, this parameter is still specifically taken into account for the diagnosis and prognosis of AMI. Our hypothesis was that serum lactate levels cannot be used to diagnose AMI or predict its outcome. Methods This was an ancillary, retrospective, observational, controlled multicenter study, approved by an Ethics Committee. Patients with AMI at adult intensive care unit (ICU) admission were included (AMI group) and matched to ICU patients without AMI (control group). Matching criteria were center, period, gender, age, and severity. Serum lactate levels were measured on day 0 (D0) and day 1 (D1) and the lactate difference (D0-D1) was calculated. Results Two hundred and seventy-four patients were included. Serum lactate levels were elevated in both groups at D0 and D1 but there was no significant difference between groups at D0 (2.7 [1.3; 5.5] vs 3.4 [1.9; 6.1] mmol/L; p = 0.284), D1 (1.8 [1.2; 3.1] vs 2.4 [1.5; 4.6] mmol/L, p = 0.547; respectively for control and AMI groups) or D0-D1. Thus, the performance of serum lactate for AMI diagnosis was poor. Concerning AMI outcome, serum lactate levels predicted ICU death in both groups at D0 and D1. Conclusions no specific association was observed between serum lactate levels and AMI. Serum lactate should not be used for the diagnosis of AMI but may help assess disease severity.

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