Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; EA 3072, Institut de Physiologie, Faculté de Médecine de Strasbourg, 67000 Strasbourg, France.
Service d'Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France.
Anaesth Crit Care Pain Med. 2022 Dec;41(6):101141. doi: 10.1016/j.accpm.2022.101141. Epub 2022 Aug 12.
Early diagnosis and prompt management of acute mesenteric ischaemia (AMI) are key to survival but remain extremely difficult, due to vague and non-specific symptoms. Serum lactate (SL) is commonly presented as a useful biomarker for the diagnosis or prognosis of AMI. The aim of our study was test SL (1) as a diagnostic marker and (2) as a prognostic marker for AMI.
This was an ancillary multicentre case-control study. Patients with AMI at intensive care unit (ICU) admission were included (AMI group) and matched to ICU patients without AMI (control group). SL was measured and compared on day 0 (D0) and day 1 (D1). Diagnosis and prognosis accuracy were assessed by receiver operating characteristic (ROC) and their area under the curve (AUC).
Each group consisted of 137 matched ICU patients. There was no significant difference of SL between the two groups at D0 or at D1 (p = 0.26 and p = 0.29 respectively). SL was a poor marker of AMI: at D0 and D1, AUC were respectively 0.57 [0.51; 0.63] and 0.60 [0.53; 0.67]. SL at D0 and D1 correctly predicted ICU mortality, independently of AMI (AUC D0: 0.69 [0.59; 0.79] vs. 0.74 [0.65; 0.82]; p = 0.51 and D1: 0.74 [0.64; 0.84] vs. 0.76 [0.66; 0.87]; p = 0.77, respectively, for control and AMI groups].
SL has no specific link with AMI, both for diagnosis and prognosis. SL should not be used for the diagnosis of AMI but, despite its lack of specificity, it may help to assess severity.
急性肠系膜缺血（AMI）的早期诊断和及时治疗是生存的关键，但由于症状模糊且非特异性，这仍然极其困难。血清乳酸（SL）通常被认为是诊断或预测 AMI 的有用生物标志物。本研究旨在检验 SL：（1）作为诊断标志物；（2）作为 AMI 的预后标志物。
这是一项辅助性多中心病例对照研究。纳入入住重症监护病房（ICU）时发生 AMI 的患者（AMI 组），并与无 AMI 的 ICU 患者（对照组）相匹配。在第 0 天（D0）和第 1 天（D1）测量并比较 SL。通过接收者操作特征（ROC）及其曲线下面积（AUC）评估诊断和预后准确性。
每组均包括 137 例匹配的 ICU 患者。两组在 D0 或 D1 时的 SL 无显著差异（p = 0.26 和 p = 0.29）。SL 是 AMI 的一个较差标志物：在 D0 和 D1 时，AUC 分别为 0.57 [0.51；0.63]和 0.60 [0.53；0.67]。D0 和 D1 时的 SL 可独立于 AMI 正确预测 ICU 死亡率（AUC D0：0.69 [0.59；0.79] 与 0.74 [0.65；0.82]；p = 0.51 和 D1：0.74 [0.64；0.84] 与 0.76 [0.66；0.87]；p = 0.77，对于对照组和 AMI 组）。
SL 与 AMI 既无特定关联，也无诊断或预后关联。SL 不应用于 AMI 的诊断，但尽管其缺乏特异性，它可能有助于评估严重程度。
