The diagnostic accuracy of serum lactate among patients with acute intestinal ischemia; A systematic review and meta-analysis

Abstract

Acute intestinal ischemia (AII) is a rare but severe medical emergency with high mortality, particularly when surgical intervention is delayed, and early diagnosis remains challenging due to the limitations of current diagnostic tools. This diagnostic test accuracy meta-analysis aimed to synthesise evidence on the diagnostic performance of serum lactate, D-lactate, and L-lactate levels for the early diagnosis of AII. A systematic search of 10 databases and registries, including PubMed, EMBASE, and ClinicalTrials.gov, was conducted up to 9 September 2024. Thirteen studies involving 1,978 patients (600 with AII) were included. The pooled sensitivity and specificity of serum lactate were 0.84 (95% CI: 0.81–0.87, I²=82.2%) and 0.60 (95% CI: 0.57–0.62, I²=96.5%), respectively, with an area under the curve (AUC) of 0.836. D-lactate demonstrated higher diagnostic performance, with pooled sensitivity and specificity of 0.94 (95% CI: 0.89–0.98, I²=70.5%) and 0.54 (95% CI: 0.46–0.61, I²=96.4%), respectively, and an AUC of 0.9015. L-lactate showed pooled sensitivity and specificity of 0.81 (95% CI: 0.72–0.87, I²=76.4%) and 0.68 (95% CI: 0.64–0.72, I²=96.9%), with an AUC of 0.8288, while plasma lactate exhibited sensitivity and specificity of 0.82 (95% CI: 0.78–0.86, I²=86.7%) and 0.56 (95% CI: 0.53–0.60, I²=97.3%), with an AUC of 0.8196. All included studies showed a low risk of applicability concerns regarding patient selection, though two had unclear risk concerning the index test. Significant heterogeneity was observed across studies. Overall, lactate levels—particularly D-lactate—demonstrate promise as biomarkers for early AII diagnosis. However, variability in specificity and study heterogeneity necessitate further validation before routine clinical application. Integrating lactate biomarkers with other diagnostic modalities may enhance early detection and improve patient outcomes. This review was registered in the Prospective Register of Systematic Reviews (PROSPERO) under CRD42024583735.