Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study
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Date
2013
Journal Title
Journal ISSN
Volume Title
Publisher
International journal of emergency medicine
Abstract
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
Description
Keywords
Bowel ischemia, Biomarkers, Serum lactate, Phosphate
Citation
Kintu-Luwaga, R., Galukande, M., & Owori, F. N. (2013). Serum lactate and phosphate as biomarkers of intestinal ischemia in a Ugandan tertiary hospital: a cross-sectional study. International journal of emergency medicine, 6(1), 1-7.