SERUM D(-)-LACTATE LEVELS AS AN AID TO DIAGNOSING ACUTE INTESTINAL ISCHEMIA

No serum marker has consistently proved helpful in diagnosing early ac ute mesenteric ischemia. D(-)-lactate is a product of bacterial metabo lism and was found to be elevated in peripheral blood in a rat model o f intestinal ischemia. We conducted a prospective study to evaluate pr eoperative D(-)-lactate levels in 31 patients undergoing laparotomy fo r acute abdominal emergencies, including suspected acute mesenteric is chemia. The serum was deproteinated and D(-)-lactate concentration was determined by a spectrophotometric assay. A control group was compose d of patients with a benign abdominal examination who were operated on for central venous line placement. We found significant elevations in D(-)-lactate levels in patients with mesenteric ischemia compared wit h controls (P < 0.00005), as well as in patients with other forms of a bdominal catastrophes (P < 0.00005) and with bowel obstruction (P < 0. 0005). Sensitivity and specificity were 90% and 81%, respectively. The negative predictive value was 96%, and the positive predictive value was 10%. We have found that D(-)-lactate serum levels can aid in diagn osing acute mesenteric ischemia.