D-LACTATE AS AN EARLY MARKER OF INTESTINAL ISCHEMIA AFTER RUPTURED ABDOMINAL AORTIC-ANEURYSM REPAIR

Background Patients with a ruptured abdominal aortic aneurysm (AAA) ar e at risk of developing colonic ischaemia after surgery. It is difficu lt to diagnose this ischaemia at an early stage. D-lactate is produced by intestinal bacteria after ischaemia. L-lactate is released in incr eased amounts during hypoxia by anaerobic metabolism. This study inves tigated both variables as a marker for intestinal ischaemia in patient s with a ruptured AAA. Methods Twenty-four patients with ruptured AAA were divided retrospectively into two groups with and without ischaemi c complications, as verified by colonoscopy. Blood had been taken on a dmission to the intensive care unit (ICU). Median time to colonoscopy was 9 days after surgery. As controls, four patients with pneumonia, s ix healthy subjects, five patients with an elective AAA repair, and si x patients with sepsis and acute tubular necrosis were included. Resul ts D-lactate level on admission was significantly increased in patient s with colonic ischaemia after ruptured AAA compared with the level in patients without ischaemia (P < 0.05), patients with sepsis (P < 0.00 1), those with pneumonia and healthy subjects (P < 0.01). L-lactate co ncentration was similar in the group with intestinal complications and in patients without colonic ischaemia; however, L-lactate levels were higher in patients with pneumonia and sepsis than in healthy subjects (P < 0.05). Conclusion On admission to the ICU, D-lactate, but not L- lactate, levels may predict later colonic ischaemia following repair o f a ruptured AAA.