The Value of Serial Serum Lactate Measurements in Predicting the Extent of Ischemic Bowel and Outcome of Patients Suffering Acute Mesenteric Ischemia
Open accessAbstract
Background Acute 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.Methods A retrospective study of 91 patients with clinically and pathologically confirmed AMI from January 2006 to December 2012 was performed.Results In-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).Conclusion The 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.
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High lactate levels and metabolic acidosis indicate general deterioration, systemic hypoperfusion, and high risk of death, irrespective of the cause.
“There is common agreement that high lactate levels and metabolic acidosis indicate general deterioration, systemic hypoperfusion, and high risk of death, irrespective of the cause. 129,130”
From Editor's Choice - European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins. (2025) · cites this paper as [129]
The Serial Serum Lactate and pH Values section (page unavailable) reports higher lactate in nonsurvivors with acute mesenteric ischemia; the Abstract identifies lactate as an independent mortality risk factor in that group. Materials and Methods also includes lactic acidosis as a sign of hypoperfusion in its definition of severe sepsis. The paper does not establish that lactate and metabolic acidosis together indicate deterioration or death risk irrespective of the cause. (LLM, conf=0.86)
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References 16 · Cited by 70
Research works printed but not linked: 1
- Kortmann B, Klar E. Recognizing acute mesenteric ischaemia too late: reasons and diagnostic approach from a surgical point of view. Zentralbl Chir 2005;130:223-226.
- Authors
- Studer, P., Vaucher, A., Candinas, D., & Schnüriger, B.
- Affiliations
- University Hospital of Bern (CH)
- Corresponding author
- Schnüriger, Beat
- Venue
- Journal of Gastrointestinal Surgery
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 19
- Issue
- 4
- Pages
- 751-755
- ISSN
- 1091-255X (ISSN-L)
- OpenAlex
- W1996383488
- Cited by
- 70
- References
- 16
- Citations by year
- 2026: 3 · 2025: 7 · 2024: 6 · 2023: 7 · 2022: 11 · 2021: 8 · 2020: 3 · 2019: 7 · 2018: 9 · 2017: 5 · 2016: 3
- FWCI
- 5.71
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Gastrointestinal Surgery (publishedVersion)
- PubMed (publishedVersion)
- reroDoc Digital Library (submittedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion, other-oa)
- Open Access CRIS of the University of Bern
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Keywords
- acute mesenteric ischemia, intestinal necrosis, in-hospital mortality, mortality risk factors, blood pH, prognostic factors
- MeSH terms
- Acute Disease, Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Retrospective Studies, Risk Factors, Biomarkers, Treatment Outcome, Hospital Mortality, Lactic Acid, Mesenteric Ischemia
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