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A study to use hematological and biochemical parameters as a key in the diagnosis of acute mesenteric ischemia

Yıl 2018, Cilt: 3 Sayı: 2, 53 - 56, 20.07.2018
https://doi.org/10.25000/acem.414324

Öz





Aim: Acute mesenteric ischemia is still fatal in 59-92% of cases. Delay in diagnosis of acute mesenteric ischemia can cause dramatic increase in morbidity and mortality rates.  However several diagnostic and disease related factors have been widely studied. Controversy still remains. In this study, we evaluated hematological and biochemical parameters in patients with acute mesenteric ischemia.

Methods: 46 patients (study group) who underwent emergent surgery for
acute mesenteric ischemia and 46 patients (control group) operated for acute
abdomen with another etiology other than acute mesenteric ischemia and
internalized to intensive care unit were included in this study. Medical
records and clinical data of acute mesenteric ischemia patients between January
2008 and December 2014 were evaluated with regard to 8 parameters; age,
amylase, white blood cell count, mean platelet volume, creatine kinase, lactate
dehydrogenase, lactate and D-dimer. These parameters were selected for their
increased levels in acute mesenteric ischemia patients according to many
published medical studies. Control group was formed randomly from patients
followed in intensive care unit for their co-morbidities after acute abdomen
operation in the same period. Gender was included in the table but was not
taken into account as a parameter for the study.





Results: Mean values of age, white blood cell count, creatine kinase,
lactate dehydrogenase, lactate and D-dimer were significantly higher in acute
mesenteric ischemia group than the control group. Mean platelet volume was
significantly lower in acute mesenteric ischemia group. The p values were for
age (p=0.009), for amylase (0.475), for white blood cell (p=0.001) for mean platelet
volume (0=0.001), for creatinine kinase (p=0.017), for lactate dehydrogenase
(p=0.001), for lactate (p=0.001), for D-dimer (p=0.001) respectively.

Conclusion: White blood cell count, creatine kinase, lactate dehydrogenase, lactate and D-dimer levels increase; mean platelet volume decrease in acute mesenteric ischemia patients significantly.



Kaynakça

  • 1. Paladino NC, Inviati A, Di Paola V, Busuito G, Amodio E, Bonventre S, et al. Predictive factors of mortality in patients with acute mesenteric ischemia. Ann Ital Chir. 2014;85:265-70.
  • 2. Karabulut K, Gul M, Dundar ZD, Cander B, Kurban S, Toy H. Diagnostic and prognostic values of procalcitonin and phosphorus in acute mesenteric ischemia. Ulus Travma Cerrahi Derg. 2011;17:193-8.
  • 3. Hamzaoglu I, Ulualp K, Balkan T, Cander B, Kurban S, Toy H. Abdominal emergencies in octogenerians. Ulus Travma Acil Cerrahi Derg. 2000;6:36-8.
  • 4. Demir IE, Ceyhan GO, Friess H. Beyond lactate: Is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29:226-35.
  • 5. Turkoglu A, Gul M, Oguz A, Bozdağ Z, Ülger BV, Yılmaz A, et al. Mean platelet volume: Is it a predictive parameter in diagnosis of acute mesenteric ischemia? Int Surg. 2015;100:962-5.
  • 6. Aktimur R, Cetinkunar S, Yildirim K, Aktimur SH, Ugurlucan M, Ozlem N. Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia. Euro J Trauma Emerg Surg. 2016;42:363-8.
  • 7. Kisaoglu A, Bayramoglu A, Ozogul B, Atac K, Emet M, Atamanalp SS. Sensitivity and specificity of red cell distribution width in diagnosing acute mesenteric ischemia in patients with abdominal pain. World J Surg. 2014;38:2770-6.
  • 8. Tanrikulu Y, Tanrikulu CS, Sabuncuoglu MZ, , Temiz A, Köktürk F, Yalçın B. Diagnostic utility of the neutrophil-lymphocyte ratio in patients with acute mesenteric ischemiaia retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2016;22:344-9.
  • 9. Altintoprak F, Arslan Y, Yalkin O, Uzunoglu Y, Ozkan OV. Mean platelet volume as a potential prognostic marker in patients with acute mesenteric ischemia-retrospective study. World J Emerg Surg. 2013;8:49.
  • 10. van den Heijkant TC, Aerts BA, Teijink JA, Buurman WA, Luyer MD. Challenges in diagnosing mesenteric ischemia. World J Gastroenterol. 2013;19:1338-41.
  • 11. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004;164:1054-62.
  • 12. Corke C, Glenister K. Monitoring intestinal ischemia. Crit Care Resusc. 2001;3:176-80.
  • 13. Fried MW, Murthy UK, Hass SR, Oates RP. Creatine kinase isoenzymes in the diagnosis of intestinal infarction. Dig Dis Sci. 1991;36:1589-93.
  • 14. Yang S, Fan X, Ding W, Liu B, Meng J, Wang K, et al. D-dimer as an early marker of severity in patients with acute superior mesenteric venous thrombosis. Medicine (Baltimore). 2014;93: e270.
  • 15. Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis. 2012;33:355-61.
  • 16. Studer P, Vaucher A, Candinas D, Schnüriger B. The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia. J Gastrointest Surg. 2015;19:751-5.

Akut mezenterik iskemi tanısında hematolojik ve biyokimyasal parametrelerin bir anahtar olarak kullanımına yönelik bir çalışma

Yıl 2018, Cilt: 3 Sayı: 2, 53 - 56, 20.07.2018
https://doi.org/10.25000/acem.414324

Öz













Amaç: Akut mezenterik iskemi %59-92 oranından ölümcül seyretmektedir. Tanıda gecikme morbidite ve mortalitede ciddi artışa sebep olabilmektedir. Bu konuyla ilgili pek çok tanısal çalışma yapılmıştır. Bu çalışmada, akut mezenterik iskemisi olan hastalarda hematolojik ve laboratuar parametrelerin değerlendirilmesi amaçlandı.

Yöntem: Bu çalışmaya akut mezenterik iskemi tanısıyla acil cerrahiye giden 46 hasta ile akut abdomen sebebiyle opere edilen ve yoğun bakım ünitesine alınan 46 hasta dahil edildi. Ocak 2008 ve Aralık 2014 tarihleri arasında akut mezenterik iskemi hastalarının dosyaları tarandı. Sekiz parametre ile ilgili tablolar oluşturuldu: amilaz, beyaz küre sayısı, ortalama trombosit hacmi, kreatinin kinaz, laktat dehidrogenez, laktat ve D-dimer. Bu parametreler daha önce çeşitli çalışmalarda akut mezenterik iskemide yükselmiş olarak bulunan parametrelerdir. Kontrol grubu aynı dönemde akut abdomen sebebiyle opere edildikten sonra yoğun bakıma alınmış olan hastalardan randomize olarak seçildi. Cinsiyet tablolarda yer almakla birlikte bu çalışmada bir parametre olarak kullanılmadı.

Bulgular: Ortalama yaş, amilaz düzeyi, beyaz
küre sayısı, kreatinin kinaz, laktat dehidrogenez, laktat ve D-dimer akut
mezenterik iskemi grubunda kontrol grubuna oranla daha yüksek olarak tespit
edildi. Ortalama trombosit volumu akut mezenter iskemisi grubunda istatistiksel
olarak anlamlı derecede daha düşüktü. P değerleri yaş için 0,009, amilaz p=0,475,
beyaz küre sayısı için 0,001, kreatinin kinaz için 0,017, laktat dehidrogenaz
için 0,001, laktat içim 0,001 ve D-dimer için 0,001 idi.







Sonuç: Akut mezenterik iskemi hastalarında
beyaz küre sayısı, kreatin kinaz, laktat dehidrogenez, laktat, D-dimer sayıları
artarken ortalama trombosit hacmi belirgin olarak azalmaktadır.









Kaynakça

  • 1. Paladino NC, Inviati A, Di Paola V, Busuito G, Amodio E, Bonventre S, et al. Predictive factors of mortality in patients with acute mesenteric ischemia. Ann Ital Chir. 2014;85:265-70.
  • 2. Karabulut K, Gul M, Dundar ZD, Cander B, Kurban S, Toy H. Diagnostic and prognostic values of procalcitonin and phosphorus in acute mesenteric ischemia. Ulus Travma Cerrahi Derg. 2011;17:193-8.
  • 3. Hamzaoglu I, Ulualp K, Balkan T, Cander B, Kurban S, Toy H. Abdominal emergencies in octogenerians. Ulus Travma Acil Cerrahi Derg. 2000;6:36-8.
  • 4. Demir IE, Ceyhan GO, Friess H. Beyond lactate: Is there a role for serum lactate measurement in diagnosing acute mesenteric ischemia? Dig Surg. 2012;29:226-35.
  • 5. Turkoglu A, Gul M, Oguz A, Bozdağ Z, Ülger BV, Yılmaz A, et al. Mean platelet volume: Is it a predictive parameter in diagnosis of acute mesenteric ischemia? Int Surg. 2015;100:962-5.
  • 6. Aktimur R, Cetinkunar S, Yildirim K, Aktimur SH, Ugurlucan M, Ozlem N. Neutrophil-to-lymphocyte ratio as a diagnostic biomarker for the diagnosis of acute mesenteric ischemia. Euro J Trauma Emerg Surg. 2016;42:363-8.
  • 7. Kisaoglu A, Bayramoglu A, Ozogul B, Atac K, Emet M, Atamanalp SS. Sensitivity and specificity of red cell distribution width in diagnosing acute mesenteric ischemia in patients with abdominal pain. World J Surg. 2014;38:2770-6.
  • 8. Tanrikulu Y, Tanrikulu CS, Sabuncuoglu MZ, , Temiz A, Köktürk F, Yalçın B. Diagnostic utility of the neutrophil-lymphocyte ratio in patients with acute mesenteric ischemiaia retrospective cohort study. Ulus Travma Acil Cerrahi Derg. 2016;22:344-9.
  • 9. Altintoprak F, Arslan Y, Yalkin O, Uzunoglu Y, Ozkan OV. Mean platelet volume as a potential prognostic marker in patients with acute mesenteric ischemia-retrospective study. World J Emerg Surg. 2013;8:49.
  • 10. van den Heijkant TC, Aerts BA, Teijink JA, Buurman WA, Luyer MD. Challenges in diagnosing mesenteric ischemia. World J Gastroenterol. 2013;19:1338-41.
  • 11. Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004;164:1054-62.
  • 12. Corke C, Glenister K. Monitoring intestinal ischemia. Crit Care Resusc. 2001;3:176-80.
  • 13. Fried MW, Murthy UK, Hass SR, Oates RP. Creatine kinase isoenzymes in the diagnosis of intestinal infarction. Dig Dis Sci. 1991;36:1589-93.
  • 14. Yang S, Fan X, Ding W, Liu B, Meng J, Wang K, et al. D-dimer as an early marker of severity in patients with acute superior mesenteric venous thrombosis. Medicine (Baltimore). 2014;93: e270.
  • 15. Acosta S, Nilsson T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis. 2012;33:355-61.
  • 16. Studer P, Vaucher A, Candinas D, Schnüriger B. The value of serial serum lactate measurements in predicting the extent of ischemic bowel and outcome of patients suffering acute mesenteric ischemia. J Gastrointest Surg. 2015;19:751-5.
Toplam 16 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Cerrahi
Bölüm Orjinal Makale
Yazarlar

Mikail Çakır Bu kişi benim

Doğan Yıldırım Bu kişi benim

Ahmet Kocakuşak

Okan Murat Aktürk

Leyla Zeynep Tigrel Bu kişi benim

Yayımlanma Tarihi 20 Temmuz 2018
Yayımlandığı Sayı Yıl 2018 Cilt: 3 Sayı: 2

Kaynak Göster

Vancouver Çakır M, Yıldırım D, Kocakuşak A, Aktürk OM, Tigrel LZ. A study to use hematological and biochemical parameters as a key in the diagnosis of acute mesenteric ischemia. Arch Clin Exp Med. 2018;3(2):53-6.