The diagnostic value of procalcitonin and d-dimer levels in mesenteric ischemia

Acute mesenteric ischemia (AMI) is rarely encountered but it is a real urgent case which has a high mortality rate often due to the late diagnosis. Although the improvements in diagnostic imaging techniques, surgical techniques and intensive care unit, there has not been apperant changes in AMI high mortality rates in recent years. This is caused by continuing difficulties in trying to diagnose AMI before the bowel necrosis occurs. Inflammation that occurs in the patients with mesenteric ischemia and especially the bacteria translocation which comes into being in the ischemic bowel segment result in abdominal sepsises.This experimental study was made with a view to evoluate the procalcitonin (PCT) levels in different periods of time of the AMI which is used for the early diagnosis of sepsis today and to determine the diagnostic values of PCT levels in the diagnosis of mesenteric ischemia, and to analyse the relations between the PCT levels and D-dimer, lactate and histological scores, by considering the tendency to sepsis and bacterial translocation that occur in AMI patients.In this randomized, controlled study, 48 Spraque Dawley female rats were divided into 8 groups: Four control groups (Groups 1,3,5 and 7) and four ischemic groups (Groups 2,4,6 and 8). Collecting the blood samples for PCT, Lactate, MDA and D-dimer measurements in the 30th min. after applying only laparotomy to the control group (Group 1), 2nd hour (Group 3), 6th hour (Group 5) and 12th hour (Group 7); In the 30 min. (Group 2) after applying laparotomy to the ischemic group and then forming mesenteric ischemia by clamping the superior mesenteric artery, 2nd hour (Group 4), 6th hour (Group 6) and in the 12th hour (Group 8) and determination of the histological damage scores of the groups and compare them were planned.Rats in the Group 8, blood samples of which were planned to be collected after applying the mesenteric artery ligation died within 6-12 hours. Therefore, Group 8 and Group 7, as the control group of the 8th Group, blood samples of which also were planned to be collected after applying only laparotomy were not included in the further evoluation. According to the results of our study, lactate levels between only 2-hours control group (Group 3) and the ischemic group (Group 5), and PCT levels between 6-hours control group (Group 4) and the ischemic group (Group 6) were significantly different (for lactate p=0.017; for procalcitonin p= 0.005) when compairing the biochemical parameters between the ischemic groups and control groups in the same period of time. There were not a considerable difference in all other comparisons (for all periods of time and all comparisons p>0.05). In the histopathological damage comparisons of control groups and ischemic groups in the same period of time, there were obviously more damage in the ischemic groups (for 30 min. p= 0.009, 2 h. p= 0.04, 6 h. p= 0.001). Only D-dimer and lactate levels showed a significant positive correlation with each other when the corelation of biochemical parameters were analysed. For histopathological damage and biochemical parameters, only there were strong and significant positive correlation between lactate levels.In conlusion, only lactate levels show statistically significant increase in biochemical parameters which were evoluated in the early period in AMI. These result suggests that only lactate levels are useful for the early diagnosis of AMI. Although PCT levels increasing in the late periods of mesenteric ischemia may not be used for the early diagnosis, it can be important to show the proceed of ischemia and the beginning of bacterial translocation. Within this aspect, PCT levels which have the potential to be a parameter that can be used for prognostic purpose must be taken into consideration with the clinical studies.