Ulus Travma Acil Cerrahi Derg. 2020; 26(1): 86-94 | DOI: 10.14744/tjtes.2019.61580

Akut mezenterik iskemi hastalarýnda L-laktat, D-dimer, lökosit, CRP ve nötrofil/lenfosit oranýnýn prediktif ve prognostik deðeri

Sabahattin Destek¹, Ayþegül Yabacý², Yaðmur Nur Abik¹, Vahit Onur Gül³, Kamuran Cumhur Deðer^1
1Bezmialem Vakýf Üniversitesi Týp Fakültesi, Genel Cerrahi Anabilim Dalý, Ýstanbul
²Bezmialem Vakýf Üniversitesi Týp Fakültesi, Ýstatistik Anabilim Dalý, Ýstanbul
³Gülhane Eðitim Araþtýrma Hastanesi, Genel Cerrahi Kliniði, Ankara

AMAÇ: Akut mezenterik iskemi (AMÝ) baðýrsaklarý besleyen mezenterik damarlarýn obstrüksiyonuyla baðýrsaklarda iskemiye neden olan, mortalite oraný %80’i bulan hastalýk grubudur. Ýnsidansý 100.000’de kiþi baþýna 0.63’tür. Saðkalým için erken taný ve tedavi çok önemlidir. AMÝ’nin farklý tip ve aþamalarýný yansýtabilen ideal bir biobelirteç yoktur. Çalýþmamýzda AMÝ tanýsýyla ameliyat edilen hastalarda ameliyat öncesi aþamada L-laktat, D-dimer, lökosit, C-reaktif protein (CRP) ve nötrofil/lenfosit oranýnýn (NLO) prediktif ve prognostik önemi araþtýrýldý.
GEREÇ VE YÖNTEM: Bu çalýþmada 2015–2019 tarihleri arasýnda AMÝ tanýsý ile ameliyat edilen 44 hasta incelendi. Çalýþmaya alýnan hastalarýn demografik, klinik, radyolojik, laboratuvar, cerrahi bulgularý dahil edildi. Hastalar etiyolojik olarak AMÝ grubuna göre gruplandýrýldý. Bu hastalarýn L-laktat, D-dimer, CRP, lökosit, NLO seviyeleri belirlendi. AMÝ gruplarýna göre istatiksel analiz yapýldý.
BULGULAR: Çalýþmaya alýnan 44 hastanýn yaþ ortalamasý 67.7 yýl, kadýn erkek oraný 0.76 idi. Tomografi bulgularýna göre hastalarýn %31.8’inde (n=14) mezenter arter embolisi, %29.5’inde (n=13) mezenter arter trombüsü, %25 (n=11) hastada mezenter ven trombüsü, %13.6’sýnda (n=6) non-oklüsiv mezenter iskemi saptandý. AMÝ tipleriyle karþýlaþtýrýldýðýnda D-dimer ve CRP testleri diðer markýrlara göre anlamlý þekilde farklý bulundu. Toplam yatýþ süresi ile L-laktat (p=0.047) ve CRP (p=0.045) ile anlamlý bir korelasyon saptandý. Yapýlan analizlerde tüm AMÝ tiplerinde mezenter iskemi tanýsýnda kullanýlabilecek ortak biyobelirteç CRP olmuþtur.
TARTIÞMA: Ameliyat öncesi özellikle CRP düzeyinin AMÝ tanýsýnda, alt tipini belirlemede ve klinik seyrini belirlemede etkin þekilde kullanýlabilir. Ancak L-laktat, D-dimer, lökosit ve nötrofil/lenfosit oranlarýnýn tüm AMÝ alt tiplerinin tanýsýný koymada etkinliði yoktur.

Anahtar Kelimeler: Akut mezenter iskemi, CRP; D-dimer; L-laktat; lökosit; nötrofil/lenfosit oraný.

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Predictive and prognostic value of L-lactate, D-dimer, leukocyte, C-reactive protein and neutrophil/lymphocyte ratio in patients with acute mesenteric ischemia

Sabahattin Destek¹, Ayþegül Yabacý², Yaðmur Nur Abik¹, Vahit Onur Gül³, Kamuran Cumhur Deðer^1
1Department of General Surgery, Bezmialem Foundation University Faculty of Medicine, Ýstanbul-Turkey
²Department of Statistic, Bezmialem Foundation University Faculty of Medicine, Ýstanbul-Turkey
³Department of General Surgery, Gülhane Training and Research Hospital, Ankara-Turkey

BACKGROUND: Acute mesenteric ischemia (AMI) is a disease that causes an ischemia in the intestines due to the obstruction of the mesenteric vessels feeding the intestines, with a mortality rate reaching up to 80%. The overall incidence of AMI is 0.63 per 100,000 people. Early diagnosis and treatment are very important for survival. There is no ideal biomarker that can reflect different types and stages of AMI. This study investigated the predictive and prognostic value of L-lactate, D-dimer, leukocyte, C reactive protein (CRP) and neutrophil/lymphocyte ratio (NLR) in the preoperative period were investigated in patients operated for AMI.
METHODS: A total of 44 patients operated for AMI between 2015 and 2019 were evaluated in this study. Demographic, clinical, radiological, laboratory and surgical findings of the patients included in this study were recorded. The patients were divided into groups according to the etiological type of AMI. L-lactate, D-dimer, CRP, leukocyte, and NLR levels of these patients were determined. Statistical analysis was performed according to AMI groups.
RESULTS: The mean age of the 44 patients included in this study was 67.7 years and the female to male ratio was 0.76. According to tomography results, 31.8% (n=14) of the patients had mesenteric artery embolism, 29.5% (n=13) had mesenteric artery thrombus, 25% (n=11) had mesenteric vein thrombus and 13.6% (n=6) had non-occlusive mesenteric ischemia. When AMI types were compared, D-dimer and CRP levels were found to be significantly different from other markers. The total length of stay in the hospital was found to be significantly correlated with the L-lactate (p=0.047) and CRP (p=0.045) levels. In the analyses, CRP was determined to be the common biomarker that could be used in the diagnosis of mesenteric ischemia in all AMI types.
CONCLUSION: Particularly, the CRP level can be used effectively in the preoperative period to diagnose AMI and to determine its subtype and clinical course. However, L-lactate, D-dimer, leukocyte and NLR are markers that have no predictive value in the diagnosis of all AMI subtypes.

Keywords: Acute mesenteric ischemia, C-Reactive protein; D-dimer; L-lactate; Leukocyte; neutrophil/lymphocyte ratio.

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