Role of Lactate as a Marker for Predicting Early Surgical Intervention in a Case of Acute Abdomen

Abstract

Background

Acute abdomen is a common surgical emergency requiring timely differentiation between cases needing surgical intervention and those manageable with conservative treatment. Delayed surgical decisions in acute abdomen cases can lead to increased morbidity and mortality, making the identification of reliable early biomarkers crucial for improving clinical outcomes. Lactate, a product of anaerobic metabolism, has gained attention as a potential prognostic marker in critical care settings. However, its role in distinguishing between surgical and non-surgical acute abdomen cases remains underexplored. This study aims to evaluate the diagnostic and predictive accuracy of serum and peritoneal fluid lactate levels in determining the need for early surgical intervention in acute abdomen cases.

Objectives

The study aims to assess the significance of lactate levels as an early predictor of surgical intervention in acute abdomen cases by analyzing its correlation with intraoperative findings and postoperative outcomes. The study also evaluates the comparative utility of serum and peritoneal lactate levels, their diagnostic accuracy, and the overall cost-effectiveness of using lactate as a decision-making tool in emergency surgical settings.

Methods

This prospective observational study was conducted over one year (January–December 2022) at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna), enrolling 70 patients presenting with acute abdomen. Patients were categorized into Group A (surgical acute abdomen) and Group B (non-surgical acute abdomen) based on intraoperative findings or final treatment decisions. Blood and peritoneal fluid lactate levels were measured at admission and correlated with intraoperative observations, histopathological findings, and patient outcomes. The study employed ROC curve analysis to determine the diagnostic accuracy of lactate levels, and statistical significance was assessed using independent t-tests and chi-square analysis, with a p-value <0.05 considered significant.

Results

The mean peritoneal lactate level was significantly higher in Group A (surgical cases) than in Group B (non-surgical cases) (p<0.0001), reinforcing its diagnostic potential. A cut-off value of peritoneal fluid lactate at 5.3 mmol/L yielded the highest sensitivity (88%) and specificity (92%) for predicting surgical necessity, while serum lactate showed lower predictive accuracy. Patients with peritoneal lactate levels >6.5 mmol/L were significantly more likely to develop postoperative complications such as sepsis, wound infection, and prolonged ICU stay (p=0.002). The ROC curve analysis demonstrated

an AUC of 0.89 for peritoneal lactate, confirming its strong predictive value. The study further highlighted that early decision-making based on lactate levels reduced the rate of delayed surgical interventions and improved postoperative outcomes.

Conclusion

This study establishes peritoneal fluid lactate as a highly accurate biomarker for differentiating surgical from non-surgical acute abdomen cases, outperforming serum lactate in predicting the need for early surgical intervention. A threshold peritoneal lactate value of 5.3 mmol/L offers high sensitivity and specificity, making it a valuable diagnostic adjunct in emergency settings. Early lactate-based decision-making can reduce delays in surgical management, improve postoperative recovery, and minimize complications. Given its cost-effectiveness and ease of measurement, lactate should be integrated into emergency diagnostic protocols for acute abdomen assessment.