Lactate has been evaluated as a prognostic tool utilized in early goal directed therapy. An end product of anaerobic metabolism, it is associated with mortality in shock states. Accordingly, the objective of this study was to determine if increased serum lactate levels portend a worse outcome in acute intestinal infarction.
This was a retrospective study undertaken at a tertiary academic medical center in Kansas City, Kansas. We conducted a search of our discharge database and incorporated all serum lactate measurements from July 2004 through June 2007. We sought patients diagnosed with acute intestinal infarction with measured serial serum lactate levels. Mortality comparisons were determined using Fisher's exact test.
Of 60,033 inpatient records examined, 90 patients (0.15%) were diagnosed with acute vascular insufficiency of the intestine. 50/90 (56%) had at least one serum lactate drawn. Mortality rates due to intestinal infarction increased as serum lactate levels increased. Three of 23 patients (13%) with all serum lactates < 4.0 mmol/L did not survive. Conversely, 19 of 27 patients (70%) who had at least one serum lactate ≥ 4.0 mmol/L had higher in-hospital mortality, demonstrating a significant difference in fatal outcome between these two groups (p < 0.0001; O.R. 15.83). Lactate ≥ 4.0 mmol/L was 86.3% (95% C.I. 65.1 to 97.1%) sensitive, and 71.4% (95% C.I. 51.3 to 86.8%) specific for in-hospital mortality.
In patients diagnosed with acute intestinal infarction, with at least one serum lactate ≥ 4.0mmol/L, hospital mortality was 70%. While lactate is not a predictor of outcome, a lactate < 4.0 mmol/L demonstrates good negative predictive value (87%) for mortality in patients with acute infarction of the intestine.
Intestinal infarction is a rare, but potentially lethal event. Lactate is associated with a higher mortality in a number of shock states. Intestinal infarction may be a masquerader of shock, and therefore serum lactate levels maybe used as a prognosticator for inpatient survival in these patients.
Jiten Patel, No Financial Disclosure Information; No Product/Research Disclosure Information