Exploring D-lactate as a biomarker for acute intestinal necrosis in 2958 patients: a prospective cross-sectional study

Purpose Timely diagnosis of acute intestinal necrosis (AIN) is lifesaving but challenging due to unclear clinical presentation. D-lactate has been proposed as an AIN biomarker and we aimed to test the diagnostic performance in a clinical setting. Methods We performed a cross-sectional prospective study, including all adult patients with acute referral to a single tertiary gastrointestinal surgical department during 2015-2016 and supplemented by enrolment of high-risk in-hospital patients suspected of having AIN during 2016-2019. AIN was verified intraoperatively, and D-lactate was analyzed using an automatic spectrophotometric set-up. A D-lactate cut-off for AIN was estimated using the receiver operating characteristic curve. The performance according to patient subgroups was estimated using the area under receiver operating characteristic curve (AUC). Given the exploratory nature of this study, a formal power calculation was not feasible. Results Forty-four AIN patients and 2914 controls were enrolled. The D-lactate cut-off was found to be 0.0925 mM. Due to lipemic interference, D-lactate could not be quantified in half of the patients, leaving 23 AIN patients and 1456 controls for analysis. The AUC for the diagnosis of AIN by D-lactate was 0.588 (95% CI: 0.475; 0.712), with a sensitivity of 0.261 and specificity of 0.892. Analysis of high-risk patients showed similar results (AUC 0.579 (95% CI: 0.422; 0.736)). Conclusion D-lactate showed low sensitivity for AIN in both average-risk and high-risk patients. Moreover, lipemic interference precluded valid spectrophotometric assessment of D-lactate in half of the patients, further disqualifying the clinical utility of D-lactate as a diagnostic marker for AIN.