A Brillantino1, F Iacobellis2, A Renzi3, R Nasti4, L Saldamarco4, M Grillo5, L Romano6, M Castriconi5, A Cittadini7, M De Palma5, M Scaglione8,9, N Di Martino10, R Grassi2, F Paladino4. 1. Emergency Department "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. antonio_brillantino@libero.it. 2. Department of Radiology, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy. 3. Pelvic Care Center, "Villa delle Querce" Hospital, Via B. Caracciolo 48, Naples, Italy. 4. Emergency Department "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. 5. Department of Surgery, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. 6. Department of Radiology, "A. Cardarelli" Hospital, Via A. Cardarelli 9, 80131, Naples, Italy. 7. Department of Medical Translational Sciences, University "Federico II", Via Pansini 5, 80131, Naples, Italy. 8. Department of Diagnostic Imaging, "Pineta Grande" Hospital, Via Domitiana Km 30.000, 81030, Castel Volturno, CE, Italy. 9. Department of Radiology, University Hospitals of North Midlands, Newcastle Rd, Stoke-on-Trent, ST4 6QG, UK. 10. Department of Surgery, Second University of Naples, Piazza Miraglia 2, 80138, Naples, Italy.
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.
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.
Authors: D Berritto; F Iacobellis; F Somma; M Corona; A Faggian; A Iacomino; B Feragalli; L Saba; M La Porta; R Grassi Journal: J Biol Regul Homeost Agents Date: 2013 Jul-Sep Impact factor: 1.711
Authors: Andrew S Miller; Kathryn Boyce; Benjamin Box; Matthew D Clarke; Sarah E Duff; Niamh M Foley; Richard J Guy; Lisa H Massey; George Ramsay; Dominic A J Slade; James A Stephenson; Phil J Tozer; Danette Wright Journal: Colorectal Dis Date: 2021-02 Impact factor: 3.917
Authors: Francesca Iacobellis; Donatella Narese; Daniela Berritto; Antonio Brillantino; Marco Di Serafino; Susanna Guerrini; Roberta Grassi; Mariano Scaglione; Maria Antonietta Mazzei; Luigia Romano Journal: Diagnostics (Basel) Date: 2021-05-30