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Cited by 31Abdominal vascular conditions and treatmentsInflammatory Biomarkers in Disease PrognosisSepsis Diagnosis and Treatment

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

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Destek, Sabahattin·2020·Turkish Journal of Trauma and Emergency Surgery
DOI 10.14744/tjtes.2019.61580
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Abstract

BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that causes an ischemia in the intestines due to the obstruction of the mesenteric vessels feeding the intestines, with a mortality rate reaching up to 80%. The overall incidence of AMI is 0.63 per 100,000 people. Early diagnosis and treatment are very important for survival. There is no ideal biomarker that can reflect different types and stages of AMI. This study investigated the predictive and prognostic value of L-lactate, D-dimer, leukocyte, C reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the preoperative period were investigated in patients operated for AMI. METHODS: A total of 44 patients operated for AMI between 2015 and 2019 were evaluated in this study. Demographic, clinical, radiological, laboratory and surgical findings of the patients included in this study were recorded. The patients were divided into groups according to the etiological type of AMI. L-lactate, D-dimer, CRP, leukocyte, and NLR levels of these patients were determined. Statistical analysis was performed according to AMI groups. RESULTS: The mean age of the 44 patients included in this study was 67.7 years and the female to male ratio was 0.76. According to tomography results, 31.8% (n=14) of the patients had mesenteric artery embolism, 29.5% (n=13) had mesenteric artery thrombus, 25% (n=11) had mesenteric vein thrombus and 13.6% (n=6) had non-occlusive mesenteric ischemia. When AMI types were compared, D-dimer and CRP levels were found to be significantly different from other markers. The total length of stay in the hospital was found to be significantly correlated with the L-lactate (p=0.047) and CRP (p=0.045) levels. In the analyses, CRP was determined to be the common biomarker that could be used in the diagnosis of mesenteric ischemia in all AMI types. CONCLUSION: Particularly, the CRP level can be used effectively in the preoperative period to diagnose AMI and to determine its subtype and clinical course. However, L-lactate, D-dimer, leukocyte and NLR are markers that have no predictive value in the diagnosis of all AMI subtypes.

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  • Every 6-hour delay in CT angiography doubles mortality rates in acute mesenteric ischemia.

    “as studies have shown that every 6 h delay doubles mortality rates [21,26].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [21]

    The Introduction (p. 2) says CT angiography should be performed as soon as possible and reports lower mortality with intervention in the first six hours than after 24 hours. It does not say that each six-hour delay in CT angiography doubles mortality; its mortality figures concern timing of intervention, not successive delays in imaging. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Mesenteric venous thrombosis may present with bowel wall thickening, pneumatosis, splenomegaly, and ascites, with portal and mesenteric venous gas strongly indicating bowel infarction.

    “Mesenteric venous thrombosis may present with findings of bowel wall thickening, pneumatosis, splenomegaly, and ascites, with portal and mesenteric venous gas strongly indicating bowel infarction [21].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [21]

    The Discussion (p. 7) describes portal venous gas and pneumatosis intestinalis as specific radiological signs, but does so in its discussion of non-occlusive mesenteric ischemia, not mesenteric venous thrombosis. Its discussion of venous thrombosis (p. 8) does not report bowel wall thickening, splenomegaly, ascites, or mesenteric venous gas, and does not say that gas strongly indicates bowel infarction. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

  • Specific markers such as L-lactate, D-dimer, leukocytosis, and neutrophil-to-lymphocyte ratio may not have strong predictive value in acute mesenteric ischemia.

    “However, other studies have indicated that specific markers like L-lactate, D-dimer, leukocytosis, and neutrophil-to-lymphocyte ratio may not have strong predictive value [21].”

    From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [21]

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Research works printed but not linked: 4

  1. [2]2. Acosta S, Ogren M, Sternby NH, Bergqvist D, Björck M. Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery: autopsy findings in 213 patients. Ann Surg 2005;241:516-22. [CrossRef]
  2. [6]6. Clair DG, Beach JM. Mesenteric Ischemia. N Engl J Med 2016;374:959-68. [CrossRef]
  3. [8]8. Luther B, Mamopoulos A, Lehmann C, Klar E. The Ongoing Challenge of Acute Mesenteric Ischemia. Visc Med 2018;34:217-23. [CrossRef]
  4. [10]10. Florim S, Almeida A, Rocha D, Portugal P . Acute mesenteric ischaemia: a pictorial review. Insights Imaging 2018;9:673-82. [CrossRef]

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Authors
Destek, S.
Affiliations
Bezmiâlem Vakıf Üniversitesi Hastanesi (TR)
Corresponding author
Destek, Sabahattin
ORCID
Destek, Sabahattin
Venue
Turkish Journal of Trauma and Emergency Surgery
Publisher
Kare Publishing
Published
2020
Volume
26
Issue
1
Pages
86-94
ISSN
  • 1300-6738 (ISSN-L)
  • 1306-696X
DOI
10.14744/tjtes.2019.61580
OpenAlex
W2999226972
Cited by
31
References
10
Citations by year
2025: 4 · 2024: 7 · 2023: 8 · 2022: 7 · 2021: 4 · 2020: 1
FWCI
4.58
Type
journal article
Language
en
Open access
Licence
cc-by-nc
Locations
  • Turkish Journal of Trauma and Emergency Surgery (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
  • Health Sciences › Medicine › Oncology › Inflammatory Biomarkers in Disease Prognosis
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
acute mesenteric ischemia, L-lactate, D-dimer, C-reactive protein, neutrophil-to-lymphocyte ratio, white blood cell count, inflammatory markers, prognostic factors, mesenteric artery embolism, nonocclusive mesenteric ischemia, length of hospital stay
MeSH terms
Acute Disease, Aged, C-Reactive Protein, Female, Fibrin Fibrinogen Degradation Products, Humans, Lactates, Lymphocytes, Male, Neutrophils, Predictive Value of Tests, Prognosis, Mesenteric Ischemia

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