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

Diagnosing bowel ischaemia (BI) can be challenging with non-specific clinical, biochemical and radiological findings. We aimed to identify biomarkers in peritoneal fluid that could be utilised to enhance the diagnosis of BI. Methods: A prospective single-centre observational study was conducted with adult patients undergoing laparotomy for suspected BI. Samples of preoperative serum and intraoperative peritoneal fluid were analysed. Patients with bowel perforation were excluded. Results: Sixty-nine patients were identified; 5 were excluded for bowel perforation and 6 for incomplete data. Thirty-four patients had BI intraoperatively and were allocated to the ischaemia group; 24 did not have features of BI intraoperatively and were allocated to the control group. The ischaemia group had significantly higher median peritoneal fluid lactate (3.9 vs 1.2 mmol/L; p = 0.002) and pyruvate (190 vs 114 ümol/L; p = 0.003); as well as significantly higher mean serum white cell count (16.23 x 109/L vs 9.77 x 109/L; p = 0.001), neutrophils (13.97 x 109/L vs 7.03 x 109/L; p 0.001) and C-reactive protein (95.56 vs 53.42 mg/L; p = 0.039). The area under the curve (AUC) was the greatest for peritoneal fluid lactate (0.770), followed by pyruvate (0.751); the composite AUC for these peritoneal fluid and serum biomarkers was 0.901.

BI was associated with elevated peritoneal fluid lactate and pyruvate. Introducing a composite analysis of these peritoneal fluid and serum biomarkers could improve the diagnosis of BI in surgical practice.