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Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study

BACKGROUND: Intestinal ischemia is a common complication of intestinal obstruction and arises from impaired perfusion. The resultant local and systemic inflammatory response and bacterial translocation come with a significant degree of morbidity and mortality. This study therefore aimed to investiga...

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Autores principales: Kintu-Luwaga, Ronald, Galukande, Moses, Owori, Francis N
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177190/
https://www.ncbi.nlm.nih.gov/pubmed/24304560
http://dx.doi.org/10.1186/1865-1380-6-44
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author Kintu-Luwaga, Ronald
Galukande, Moses
Owori, Francis N
author_facet Kintu-Luwaga, Ronald
Galukande, Moses
Owori, Francis N
author_sort Kintu-Luwaga, Ronald
collection PubMed
description BACKGROUND: Intestinal ischemia is a common complication of intestinal obstruction and arises from impaired perfusion. The resultant local and systemic inflammatory response and bacterial translocation come with a significant degree of morbidity and mortality. This study therefore aimed to investigate the predictive value of elevated levels of serum lactate and phosphate as biomarkers of intestinal ischemia among patients with mechanical intestinal obstruction. METHODS: This was a cross-sectional analytical study done at Mulago Hospital in Uganda. Ethical approval was obtained. All eligible patients had a blood sample drawn for assay analysis. Determination of bowel ischemia status was by physical examination at laparotomy. Analyses were performed using Stata software, version 10.1, and 2 × 2 tables were used to calculate sensitivity and specificity. RESULTS: Serum lactate was predictive of bowel ischemia, while phosphate was not. Of the 81 patients enrolled 70 qualified for analysis; 40/70 (57%) had ischemic bowel, while 30/70 (43%) had normal bowel. Among those with ischemic bowel, 28/40 (70%) had reversible ischemia, and 12/40 (30%) had irreversible ischemia. Serum lactate assay had a sensitivity of 66% and specificity of 53% for bowel ischemia in general and a higher sensitivity of 71% and specificity of 80% for irreversible bowel ischemia. Lactate was predictive of bowel ischemia in general (p = 0.011), PPV = 14%, but more significantly predictive of irreversible ischemia (p = 0.009), PPV = 42%. NPV for lactate in both forms of ischemia was 93%. Hernias (33/70, 47%) were the most common cause of intestinal obstruction. CONCLUSION: Serum lactate assay had moderate sensitivity for bowel ischemia due to acute mechanical intestinal obstruction. The assay can be used to aid diagnosis of bowel ischemia in low technology settings.
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spelling pubmed-41771902014-09-30 Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study Kintu-Luwaga, Ronald Galukande, Moses Owori, Francis N Int J Emerg Med Original Research BACKGROUND: Intestinal ischemia is a common complication of intestinal obstruction and arises from impaired perfusion. The resultant local and systemic inflammatory response and bacterial translocation come with a significant degree of morbidity and mortality. This study therefore aimed to investigate the predictive value of elevated levels of serum lactate and phosphate as biomarkers of intestinal ischemia among patients with mechanical intestinal obstruction. METHODS: This was a cross-sectional analytical study done at Mulago Hospital in Uganda. Ethical approval was obtained. All eligible patients had a blood sample drawn for assay analysis. Determination of bowel ischemia status was by physical examination at laparotomy. Analyses were performed using Stata software, version 10.1, and 2 × 2 tables were used to calculate sensitivity and specificity. RESULTS: Serum lactate was predictive of bowel ischemia, while phosphate was not. Of the 81 patients enrolled 70 qualified for analysis; 40/70 (57%) had ischemic bowel, while 30/70 (43%) had normal bowel. Among those with ischemic bowel, 28/40 (70%) had reversible ischemia, and 12/40 (30%) had irreversible ischemia. Serum lactate assay had a sensitivity of 66% and specificity of 53% for bowel ischemia in general and a higher sensitivity of 71% and specificity of 80% for irreversible bowel ischemia. Lactate was predictive of bowel ischemia in general (p = 0.011), PPV = 14%, but more significantly predictive of irreversible ischemia (p = 0.009), PPV = 42%. NPV for lactate in both forms of ischemia was 93%. Hernias (33/70, 47%) were the most common cause of intestinal obstruction. CONCLUSION: Serum lactate assay had moderate sensitivity for bowel ischemia due to acute mechanical intestinal obstruction. The assay can be used to aid diagnosis of bowel ischemia in low technology settings. Springer 2013-12-04 /pmc/articles/PMC4177190/ /pubmed/24304560 http://dx.doi.org/10.1186/1865-1380-6-44 Text en Copyright © 2013 Kintu-Luwaga et al.; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Research
Kintu-Luwaga, Ronald
Galukande, Moses
Owori, Francis N
Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
title Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
title_full Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
title_fullStr Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
title_full_unstemmed Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
title_short Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
title_sort serum lactate and phosphate as biomarkers of intestinal ischemia in a ugandan tertiary hospital: a cross-sectional study
topic Original Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4177190/
https://www.ncbi.nlm.nih.gov/pubmed/24304560
http://dx.doi.org/10.1186/1865-1380-6-44
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