Serum D-lactate levels as a predictor of intestinal ischemia-reperfusion injury

Currently, no serum marker has proved helpful in diagnosing intestinal ischemia and reperfusion (I/R) injury. An experimental study was conducted to determine the value of serum D-lactate in detecting intestinal I/R injury. Thirty New Zealand White rabbits were divided into three groups of 10 animals each: sham-operation controls (S); I/R; and I/R plus mannitol treatment (M). Serum samples were obtained before operation (T₀), at the end of the ischemic period (T₁), after the first 30 min of reperfusion (T₂), and at the end of the reperfusion period (T₃). In Group S, mean D-lactate levels for T₀, T₁, and T₂ were 0 μg/dl, while T₃ was 5.8 ± 4.7 μg/dl. Before the operation (T₀), serum mean D-lactate levels were 0 μg/dl in all groups (S, I/R, M). Levels increased after 1 h of ischemia (T₁) in groups I/R (83.5 ± 25.6 μg/dl) and M (89.8 ± 19.9 μg/dl), but not in group S (0 μg/dl). The mean T₂ level in group I/R (231.6 ± 78.6 μg/dl) was statistically higher than in group M (140.1 ± 53.5 μg/dl) (P = 0.007). At the end of the reperfusion period, the mean T₃ level in group I/R (698.4 ± 360.4 μg/dl) was significantly higher than in group M (158.7 ± 61.4 μg/dl) (P = 0.000). In group I/R, mean D-lactate levels changed significantly at each time point (T₁ vs T₂, P = 0.001; T₂ vs T₃, P = 0.004). However, in group M the increase from T₁ to T₂ was significant (P = 0.012), but that from T₂ to T₃ was not (P = 0.293). As a result, the mean T₃ level was significantly higher than the T₂ level in group I/R (P = 0.004), but not in group M. This study confirmed a significance rise in D-lactate levels in animals with I/R injury compared to sham-operated and I/R injury plus M treatment. We suggest that serum D-lactate levels could be a useful marker of intestinal I/R injury before laparatomy. Accepted: 26 May 1998