PROGNOSTIC VALUE OF INTESTINAL FATTY ACID BINDING PROTEIN, L-LACTATE AND D- DIMER LEVELS, AND THEIR COMBINATION IN THE EARLY STAGE OF ACUTE MESENTERIC ISCHEMIA CONFIRMED WITH HISTOLOGICAL OUTCOMES: AN EXPERIMENTAL STUDY

EMRE ONER¹, MUGE GUNALP ENEYLI², OYA EVIRGEN³, EMINE NAZLI HAYIRLI³, ONUR POLAT², ILKER YESILKAYA⁴

¹Department of Emergency Medicine, Adana City Training and Research Hospital, Adana - Turkey - ²Department of Emergency Medicine, Ankara University Medical Faculty, Ankara - Turkey - ³Department of Histology and Embryology, Ankara University Medical Faculty, Ankara-Turkey - ⁴Department of Emergency Medicine, Kepez State Hospital, Antalya-Turkey

Introduction: Acute mesenteric ischemia (AMI) may lead to undesirable outcomes if not identified promptly. The aim of this study is to investigate the diagnostic value of intestinal fatty acid binding protein (IFABP), L-lactate and D-dimer in the early diagnosis of AMI, along with confirmation of the histological outcomes.

Materials and methods: Sixty-three female 250-300 grams Wistar-Albino rats were used in this randomized-controlled study. Rats were divided into 3 groups named as control, sham and ischemia, and each group was divided into 30th, 60th and 180th minute sub- groups. Only general anesthesia was applied in the control group. Rats in the sham group underwent laparotomy. Superior mesenteric artery ligation following laparotomy was performed under general anesthesia in the ischemia group. Blood samples taken at the spe- cified time intervals were evaluated with the prescribed biomarkers. Tissue samples from jejunum and ileum were processed by histologi- cal methods to detect correlation of ischemic changes with biochemical markers.

Results: The histological sections from both ileum and jejunum of the control group revealed no sign of ischemia. Mild to modera- te ischemia injury scores were observed in the sham group. Ischemia group had higher scores especially in the jejunal mucosa. The rise in IFABP values in ischemia group was significantly higher than the control and sham groups in the early stages (p<0.004). Compared to the control and sham groups, ischemia group revealed a significant rise in L-lactate levels in the early stages (p<0.002, p<0.001, respectively). No significant result could be obtained about the usage of D-dimer levels in the early diagnosis.

Conclusion: Findings of this study suggested that, IFABP and L-lactate levels can be helpful in the early diagnosis. Evaluation of these two biomarkers in combination seems to increase sensitivity and specificity of each other. D-dimer was found to be an insufficient biomarker to rule out non-thrombotic AMI.