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 microgram/dl, while T3 was 5. 8 +/- 4.7 micrograms/dl. Before the operation (T0), serum mean D-lactate levels were 0 microgram/dl in all groups (S, I/R, M). Levels increased after 1 h of ischemia (T1) in groups I/R (83.5 +/- 25.6 micrograms/dl) and M (89.8 +/- 19.9 micrograms/dl), but not in group S (0 microgram/dl). The mean T2 level in group I/R (231.6 +/- 78.6 micrograms/dl) was statistically higher than in group M (140.1 +/- 53.5 micrograms/dl) (P = 0.007). At the end of the reperfusion period, the mean T3 level in group I/R (698.4 +/- 360.4 micrograms/dl) was significantly higher than in group M (158.7 +/- 61.4 micrograms/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.