Succoring the challenging acute mesenteric ischemia: Feasibility of lactate dehydrogenase for evaluation of intestinal necrosis extension and mortality: Viabilidad de la lactato deshidrogenasa para evaluar la extensión de la necrosis intestinal y la mortalidad

Background: Acute mesenteric ischemia is a challenging and lethal pathology for surgeons in the emergency department due to its ambiguous clinical presentation and lack of early diagnostic markers. Serum lactate is considered a relevant biomarker in terms of duration of intestinal necrosis and prediction of mortality. However, its association has been little studied. Therefore, we evaluated the relationship between serum lactate levels on admission, the degree of intestinal necrosis and mortality in patients with acute mesenteric ischemia. Methods: We conducted a retrospective cross-sectional study with prospective database, including patients older than 18 years with mesenteric ischemia who required surgical management between January 2012 and December 2018. We describe the association between serum lactate levels on admission with duration of intestinal necrosis and mortality . . in patients with acute mesenteric ischemia. Results: 74 patients presented with acute mesenteric ischemia, 44 men and 30 women. Mean age was 73.5 ± 10.7 years. A significant association was found between serum lactate levels on admission and mortality (ROC cut-off value of 3.8 mmol/l, sensitivity 81.0% and specificity 76%, LR+3.41 (95% CI: 1.57, 7.40), LR-0.25 ( 95% CI.) -0.45)(P.001). However, no statistically significant association was found between serum lactate levels on admission and duration of intestinal necrosis (ρ = 0.195, 95% CI -0.046, -0.436, P > 0.99). A mortality classification and regression tree were fitted as post hoc analysis. Conclusions: Early diagnosis, prognosis and management of mesenteric ischemia is vital given its high morbidity and mortality. Serum lactate levels on admission can be considered a useful prognostic tool in terms of mortality in patients with acute mesenteric ischemia.