Introduction
Postoperative intestinal ischemia (PII) is a severe complication in abdominal aortic surgery. Early diagnosis is needed to commence the treatment while the ischemia is reversible. The aim of the study was to evaluate the diagnostic accuracy of L-lactate and ischemia-modified albumin (IMA) for PII detection.
Methods
We have conducted a prospective non-randomized observational cohort study in eighty patients (62 men and 18 women) with a mean age of 68.0±8.4 years undergoing elective aortic surgery. We took blood samples at precisely defined time points in relation to the surgical procedure. The primary method for intestinal ischemia detection was contrast-enhanced magnetic resonance enterocolography.
Results
We recorded six cases of PII (7.5%). Both markers had different postoperative kinetics. L-lactate was the more accurate marker in all clinically relevant postoperative time points. Postoperative kinetics showed that we must always consider the blood sampling time in relation to the procedure for proper interpretation. L-lactate proved the highest accuracy, sensitivity, and negative predictive value 24 hours after the declamping of the reconstruction. However, specificity and positive predictive value were lower. The combination of the most accurate timepoints of both markers led to an increase in specificity and positive predictive value.
Conclusion
Based on our results, the postoperative levels of L-lactate might help to detect PII if proper time points are used. IMA is a worse marker compared to L-lactate. Its value might be in the combination with other markers to improve the accuracy of prediction. Our data must be confirmed in larger studies.
This study was supported by the Ministry of Health of the Czech Republic, grant no. 17-29701A. All rights reserved.