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Peritoneal lactate as a potential biomarker for predicting the need for reintervention after abdominal surgery

Bini, Roberto MD; Ferrari, Giovanni MD; Aprà, Franco MD; Viora, Tiziana MD; Leli, Renzo MD; Cotogni, Paolo MD

Journal of Trauma and Acute Care Surgery: August 2014 - Volume 77 - Issue 2 - p 376–380
doi: 10.1097/TA.0000000000000302
Brief Reports

BACKGROUND Early diagnosis of complications after abdominal surgery is crucial to improve outcomes. This study aimed to evaluate the use of the peritoneal–serum lactate ratio and of peritoneal lactate levels applied alone for predicting the need for reintervention after abdominal surgery.

METHODS This prospective observational study included 88 patients who underwent abdominal surgery (48 emergency and 40 elective operations) and presented with fever, leukocytosis, late passage of flatus, and abdominal pain by the fourth postoperative day. The lactate levels were measured in the serum and peritoneal fluid. In total, 31 of 88 patients required reintervention. The receiver operator characteristic analysis was used to determine the best threshold value for the peritoneal-serum lactate ratio and for peritoneal lactate levels applied alone to identify patients who required reintervention.

RESULTS A peritoneal-serum lactate ratio greater than 4.5 (area under the curve, 0.865; 95% confidence interval, 0.773–0.957; p < 0.001) and a peritoneal lactate value greater than 9.1 mmol/L (area under the curve, 0.834; 95% confidence interval, 0.735–0.934; p < 0.0001) discriminated between patients who required reintervention with a sensitivity of 91.3%, a specificity of 81%, and a negative predictive value of 94.4% and a sensitivity of 81.9%, a specificity of 82%, and a positive predictive value of 89%, respectively.

CONCLUSION The results of our study support the hypothesis that the peritoneal-serum lactate ratio and the peritoneal lactate level applied alone could be safe, simple, inexpensive, noninvasive, and potentially valuable tools for the early identification of patients who require reintervention after elective or emergency abdominal surgery.

LEVEL OF EVIDENCE Diagnostic study, level III. Prognostic study, level III.

From the Department of Surgery (R.B., T.V., R.L.), and High Dependency Unit (G.F., F.A.), Ospedale S. Giovanni Bosco; and Anesthesiology and Intensive Care (P.C.), Department of Medicine, S. Giovanni Battista Hospital, University of Turin, Torino, Italy.

Submitted: December 10, 2013, Revised: March 7, 2014, Accepted: March 10, 2014.

This study was presented as abstract at the XIII European Congress of Trauma and Emergency Surgery, 2012, in Basel, Switzerland.

The authors certify that they have no affiliation with or financial involvement in any organization or entity with a direct financial interest in the subject matter or materials discussed in the manuscript (e.g., employment, consultancies, stock ownership, and honoraria).

Address for reprints: Roberto Bini, MD, Department of Surgery, Ospedale S. Giovanni Bosco, 10154, Torino, Italy; email: re.bini@libero.it.

© 2014 Lippincott Williams & Wilkins, Inc.