Despite investigating D-lactate as a potential biomarker for acute intestinal necrosis, this study found that its diagnostic performance was hindered by lipemic interference, resulting in low sensitivity and diminished clinical utility for both average-risk and high-risk patients.

The following is a summary of “Exploring D-lactate as a biomarker for acute intestinal necrosis in 2958 patients: a prospective cross-sectional study,” published in the January 2024 issue of Emergency Medicine by Straarup et al.

In pursuing a timely and lifesaving diagnosis for acute intestinal necrosis (AIN), this study investigated the diagnostic performance of D-lactate, a proposed biomarker for AIN, within a clinical setting. As a cross-sectional prospective study, the research involved all adult patients with acute referrals to a tertiary gastrointestinal surgical department from 2015 to 2016. The study was further supplemented by enrolling high-risk, in-hospital patients suspected of having AIN between 2016 and 2019. 

Intraoperative AIN verification and D-lactate analysis were carried out using an automatic spectrophotometric setup. A D-lactate cut-off for AIN was estimated using the receiver operating characteristic curve. Performance metrics were evaluated through the area under the receiver operating characteristic curve (AUC), considering patient subgroups. Despite the study’s exploratory nature, a formal power calculation was not feasible. The results revealed 44 AIN patients and 2,914 controls, establishing a D-lactate cut-off of 0.0925 mM. 

However, lipemic interference hindered the quantification of D-lactate in half of the patients, reducing the analysis cohort to 23 AIN patients and 1,456 controls. The AUC for diagnosing AIN by D-lactate was 0.588 (95% CI: 0.475; 0.712), demonstrating a sensitivity of 0.261 and specificity of 0.892. Subsequent analysis of high-risk patients exhibited similar results (AUC 0.579, 95% CI: 0.422; 0.736). In conclusion, D-lactate demonstrated low sensitivity for AIN in average-risk and high-risk patients. 

Lipemic interference posed challenges to the valid spectrophotometric assessment of D-lactate in a significant portion of the patient cohort, ultimately diminishing the clinical utility of D-lactate as a reliable diagnostic marker for AIN.

Source: sciencedirect.com/science/article/pii/S0736467924000052