AKUT EKSTREMİTE İSKEMİSİNDE SERUM LAKTAT DÜZEYİNİN MORTALİTE VE AMPUTASYON İLE İLİŞKİSİ

Yıl 2025, Cilt: 12 Sayı: 2, 277 - 282, 27.06.2025

Muhammet Hüseyin Erkan , A Nihat Baysal , Hayat Gökmengil , İlyas Selim Yılmaz , Abdullah Güner , Kadir Durgut

https://doi.org/10.34087/cbusbed.1638570

Öz

Öz
Amaç: Akut ekstremite iskemisi, ani ekstremite perfüzyon yetmezliği ile karakterize vasküler bir acil durumdur ve derhal tedavi edilmezse amputasyon veya mortaliteye yol açabilir. Bu çalışmada, acil embolektomi uygulanan ALI hastalarında preoperatif serum laktat düzeyleri ile amputasyon ve hastane içi mortalite arasındaki ilişki araştırılmıştır.
Gereç ve Yöntem: 2021-2023 yılları arasında Konya Şehir Hastanesi'nde tedavi edilen 67 hasta üzerinde retrospektif bir analiz yapılmıştır. Kronik periferik arter hastalığı, kronik böbrek yetmezliği olan veya ameliyat öncesi laktat verileri eksik olan hastalar çalışma dışı bırakıldı. Demografik bilgiler, komorbiditeler, motor-duyusal defisitler, Rutherford sınıflandırması, biyokimyasal parametreler ve 30 günlük postoperatif sonuçlar analiz edildi. Amputasyon ve mortalite için risk faktörlerini belirlemek üzere lojistik regresyon uygulandı.
Bulgular: Diabetes mellitus (DM), motor defisit, duyu defisit ve Rutherford kategori IIB amputasyon ile anlamlı şekilde ilişkiliydi. Ancak, çok değişkenli analizde yalnızca DM anlamlı bir belirleyici olarak kaldı (OR: 4.923, p=0.042). Serum laktat seviyeleri amputasyon ile anlamlı bir ilişki göstermemekle birlikte hastanede ölen hastalarda anlamlı derecede yüksek bulundu (medyan 4.1'e karşı 2.15, p=0.002). Tek değişkenli analiz, yüksek laktat seviyelerinin mortalite riskini artırdığını görüldü (OR: 2.354, p=0.003). Kreatin kinaz (CK) seviyeleri de hem ampute edilen hem de ölen hastalarda daha yüksekti, ancak çok değişkenli analizde anlamlılık kayboldu.
Sonuç: Ameliyat öncesi serum laktat düzeyleri hastane içi mortalite ile anlamlı şekilde ilişkilidir ancak amputasyon ile ilişkili değildir. DM, amputasyonun güçlü bir bağımsız öngörücüsüdür. Bu bulguları doğrulamak için daha geniş örneklemli ileri çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Akut ekstremite iskemisi , serum laktat , amputasyon , mortalite

RELATIONSHIP OF SERUM LACTATE LEVEL WITH MORTALITY AND AMPUTATION IN ACUTE LİMB ISCHEMIA

Öz

Aim; Acute limb ischemia (ALI) is a vascular emergency characterized by sudden limb perfusion failure, which may lead to amputation or mortality if not treated promptly. This study investigates the relationship between preoperative serum lactate levels and amputation and in-hospital mortality in ALI patients undergoing emergency embolectomy.
Method; A retrospective analysis was conducted on 67 patients treated at Konya City Hospital between 2021 and 2023. Patients with chronic peripheral arterial disease, chronic renal failure, or missing preoperative lactate data were excluded. Demographic information, comorbidities, motor-sensory deficits, Rutherford classification, biochemical parameters, and 30-day postoperative outcomes were analyzed. Logistic regression was performed to determine risk factors for amputation and mortality.
Results; Diabetes mellitus (DM), motor deficits, sensory deficits, and Rutherford category IIB were significantly associated with amputation. However, in multivariate analysis, only DM remained a significant predictor (OR: 4.923, p=0.042). Serum lactate levels showed no significant association with amputation but were significantly higher in patients who died in-hospital (median 4.1 vs. 2.15, p=0.002). Univariate analysis confirmed that elevated lactate levels increased mortality risk (OR: 2.354, p=0.003). Creatine kinase (CK) levels were also higher in both amputated and deceased patients, though significance was lost in multivariate analysis.
Conclusion; Preoperative serum lactate levels are significantly associated with in-hospital mortality but not amputation. DM is a strong independent predictor of amputation. Further studies with larger sample sizes are needed to validate these findings.

Anahtar Kelimeler

Acute limb ischemia , serum lactate , amputation , mortality

Etik Beyan

The study protocol was approved by KTO Karatay University Faculty of Medicine Ethics Committee (date: 06.06.2024, number: 2024/003). The study was conducted in accordance with the principles of the Declaration of Helsinki.

Destekleyen Kurum

none

Teşekkür

none

Kaynakça

• 1. Arnold J, Koyfman A, Long B. High risk and low prevalence diseases: Acute limb ischemia. The American journal of emergency medicine. 2023;74:152-158.
• 2. Eliason JL, Wakefield TW. Metabolic consequences of acute limb ischemia and their clinical implications. Seminars in vascular surgery. 2009;22(1):29-33.
• 3. Howard DP, Banerjee A, Fairhead JF, Hands L, Silver LE, Rothwell PM. Oxford Vascular Study. Population-Based Study of Incidence, Risk Factors, Outcome, and Prognosis of Ischemic Peripheral Arterial Events: Implications for Prevention. Circulation. 2015 ;132(19):1805-15.
• 4. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FG. TASC II Working Group. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Journal of vascular surgery. 2007;45 Suppl S:S5-67.
• 5. Baril DT, Ghosh K, Rosen AB. Trends in the incidence, treatment, and outcomes of acute lower extremity ischemia in the United States Medicare population. Journal of vascular surgery. 2014;60(3):669-77.e2.
• 6. Byrne RM, Taha AG, Avgerinos E, Marone LK, Makaroun MS, Chaer RA. Contemporary outcomes of endovascular interventions for acute limb ischemia. Journal of vascular surgery .2014;59(4):988-95.
• 7. Obara H, Matsubara K, Kitagawa Y. Acute Limb Ischemia. Department of Surgery, Keio University School of Medicine, Tokyo, 2018; 27: 109-114.
• 8. Walicka M, Raczyńska M, Marcinkowska K, Lisicka I, Czaicki A, Wierzba W, Franek E. Amputations of Lower Limb in Subjects with Diabetes Mellitus: Reasons and 30-Day Mortality. Journal of diabetes research. 2021;2021:8866126.
• 9. Dewi AISK, Dwipayana, P, Budhiarta AG. Prevalens peripheral arterial disease dan faktor-faktor yang memengaruhinya pada penderita diabetes melitus tipe 2 di RSUP Sanglah. Medicina, 2016;47(2).
• 10. Henke PK. Contemporary management of acute limb ischemia: factors associated with amputation and in-hospital mortality. Seminar Vascular Surgery. 2009;22(1):34-40.
• 11. Patra S, Bera S, SinhaRoy S, Ghoshal S, Ray S, Basu A, Schlattner U, Wallimann T, Ray M. Progressive decrease of phosphocreatine, creatine and creatine kinase in skeletal muscle upon transformation to sarcoma. FEBS J. 2008;275(12):3236-47.
• 12. de Carvalho EG, Corsini W, Hermes TA. Severe muscle damage after a short period of ischemia and reperfusion in an animal model. Surgery. 2023;174(2):363-368.
• 13. Currie IS, Wakelin SJ, Lee AJ, Chalmers RT. Plasma creatine kinase indicates major amputation or limb preservation in acute lower limb ischemia. Journal of Vascular Surgery. 2007;45(4):733-9.
• 14. Watson JD, Gifford SM, Clouse WD. Biochemical markers of acute limb ischemia, rhabdomyolysis, and impact on limb salvage. Seminar Vascular Surgery. 2014;27(3-4):176-81.
• 15. Reitz KM, Kennedy J, Rieser C, Hlavin C, Gershengorn HB, Neal MD, Bensen N, Linstrum K, Prescott HC, Rosengart MR, Talisa V, Hall DE, Tzeng E, Wunsch H, Yende S, Angus DC, Seymour CW. The Epidemiology of Extremity Threat and Amputation after Vasopressor-Dependent Sepsis. Annals of the American Thoracic Society. 2022;19(4):625-632.
• 16. Villar J, Short JH, Lighthall G. Lactate Predicts Both Short- and Long-Term Mortality in Patients With and Without Sepsis. Infectious diseases (Auckl). 2019;12:1178633719862776.
• 17. Aisiku IP, Chen PR, Truong H, Monsivais DR, Edlow J. Admission serum lactate predicts mortality in aneurysmal subarachnoid hemorrhage. The American journal of emergency medicine. 2016;34(4):708-12.
• 18. Boucaud-Maitre D, Ropers J, Porokhov B, Altman JJ, Bouhanick B, Doucet J, Girardin E, Kaloustian E, Lassmann Vague V, Emmerich J. Lactic acidosis: relationship between metformin levels, lactate concentration and mortality. Diabet Medicine. 2016;33(11):1536-1543.
• 19. Formica F, Avalli L, Colagrande L, Ferro O, Greco G, Maggioni E, Paolini G. Extracorporeal membrane oxygenation to support adult patients with cardiac failure: predictive factors of 30-day mortality Interactive cardiovascular and thoracic surgery. 2010b;10(5):721-6.