Bowel Ischaemia was Associated with Elevated Lactate and Pyruvate in Peritoneal fluid: A Prospective Observational...

Area of Science:

• Gastroenterology
• Surgical Diagnostics
• Biomarker Discovery

Background:

• Diagnosing bowel ischaemia (BI) presents challenges due to non-specific clinical, biochemical, and radiological findings.
• Accurate and timely diagnosis of BI is critical for patient outcomes and surgical decision-making.

Purpose of the Study:

• To identify peritoneal fluid biomarkers for enhancing the diagnosis of bowel ischaemia (BI).
• To evaluate the diagnostic utility of peritoneal fluid lactate and pyruvate in suspected BI cases.

Main Methods:

• Prospective, single-centre observational study involving adult patients undergoing laparotomy for suspected BI.
• Analysis of preoperative serum and intraoperative peritoneal fluid samples, excluding patients with bowel perforation.
• Comparison of biomarker levels between patients with and without intraoperatively confirmed BI.

Main Results:

• Patients with BI exhibited significantly higher peritoneal fluid lactate and pyruvate levels compared to controls.
• Elevated serum white cell count, neutrophils, and C-reactive protein were also observed in the BI group.
• Peritoneal fluid lactate and pyruvate showed high diagnostic accuracy (AUCs 0.770 and 0.751, respectively); a composite analysis yielded an AUC of 0.901.

Conclusions:

• Elevated peritoneal fluid lactate and pyruvate are associated with bowel ischaemia.
• A composite analysis incorporating these peritoneal fluid biomarkers and serum markers can significantly improve BI diagnosis in surgical settings.