Kinetics of d-lactate and ischemia-modified albumin after abdominal aortic surgery and their ability to predict intestinal ischemia

Acute intestinal ischemia is a severe complication of abdominal aortic surgery that is difficult to diagnose early and therefore to treat adequately and timely. In this study the perioperative kinetics of d-lactate and ischemia-modified albumin (IMA) are described and the predictive value of these m...

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Published in:Clinical biochemistry 2023-02, Vol.112, p.43-47
Main Authors: Tomandlova, Marie, Novotny, Tomas, Staffa, Robert, Smutna, Jindra, Krivka, Tomas, Kruzliak, Peter, Slaby, Ondrej, Kubicek, Lubos, Vlachovsky, Robert, Radova, Lenka, Tomandl, Josef
Format: Article
Language:English
Subjects:
Abdominal aortic aneurysm
Acute intestinal ischemia
Aortic Aneurysm, Abdominal - complications
Aortic Aneurysm, Abdominal - surgery
Aortoiliac occlusive disease
Biomarkers
Cohort Studies
d-Lactate
Humans
Ischemia - diagnosis
Ischemia - etiology
Ischemia-modified albumin
Lactic Acid
Perioperative kinetics
Serum Albumin
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Summary:Acute intestinal ischemia is a severe complication of abdominal aortic surgery that is difficult to diagnose early and therefore to treat adequately and timely. In this study the perioperative kinetics of d-lactate and ischemia-modified albumin (IMA) are described and the predictive value of these markers for the early diagnosis of acute intestinal ischemia is assessed. This non-randomised, single-centre cohort study enrolled 50 patients with abdominal aortic aneurysm (AAA) and 30 patients with aortoiliac occlusive disease (AOID). Serum d-lactate and IMA were assessed pre-, intra-, and postoperatively at eight defined time points. The highest serum d-lactate was at 6 h after complete declamping of the vascular graft. The highest predictive power of d-lactate was at 3 h after complete declamping (AUC 0.857). IMA was found to be higher in the AAA group in ischemic patients 10 min after complete declamping than in the AOID group. The highest predictive values of IMA were at 1 h after aortic cross-clamping (AUC 0.758) and 3 and 6 h after complete declamping (0.745 and 0.721, respectively). Moreover, the multivariate model with both markers at 3 h after complete declamping improved the detection of intestinal ischemia (AUC 0.894). Serum levels of IMA and d-lactate seem to be influential predictive markers for postoperative intestinal ischemia, especially after 3 h from complete declamping of vascular reconstruction.
ISSN:0009-9120
1873-2933
DOI:10.1016/j.clinbiochem.2022.12.002