A Review of the Predictive Role of Plasma D-Lactate Level in Acute Appendicitis: A Myth or Truth?

Table 1

Study feature	Kwan and Nager	Caglayan et al.	Demircan et al.	Vahl et al.	Duzgun et al.	Filiz et al.	Kavakli et al.
Setting	Pediatrics	Pediatric surgery	Pediatric surgery	Surgery	Surgery	Surgery	ED
Subject group	Pediatric	Pediatric	Pediatric	Adult	Adult	Adult	Adult
Design	Prospective, observational	Prospective	Prospective	Cross-sectional study	Prospective	Prospective	Retrospective
No. of subjects	230	53	44	200	32	80	36
Measured laboratory parametres	WBC, D-lactate, CRP, PCT, absolute neutrophil count	WBC, D-lactate, CRP	D-lactate	WBC, D-lactate, ESR, amylase, haemoglobin, creatinine	WBC, D-lactate, CRP	D-lactate	WBC, D-lactate, CRP
Major outcome variable	Laboratory tests in patients with abdominal pain suspicious for AA	D-lactate levels in patients with undergoing surgery for AA.	D-lactate levels in identifying the type of AA.	Laboratory tests for the surgical decision.	D-lactate levels in the diagnosis of AA.	D-lactate levels in the early diagnosis of AA.	Laboratory tests in accuracy of preoperative AA diagnosis.
Results	Mean values of WBC, CRP, PCT, and absolute neutrophil count in patients with definitive AA were significantly higher than in subjects with no definitive AA. D-Lactate levels were noncorrelative.	Levels of the D-lactate, CRP, and leukocyte counts in the surgical patients were significantly higher than the healthy patients.	Patients with perforated appendicitis had higher D-lactate levels (3.970 +/− 0.687 mg/dL) than patients in the control group (0.478 +/− 0.149 mg/dL) and patients with AA (1.409 +/− 0.324 mg/dL; P < 0.05).	The mean plasma D-lactate concentration and ESR were statistically significantly more often increased in the operated patients than in those treated conservatively.	D-lactate level was greater than 0.25 mmol/L in AA, the specificity was 60%, the false negative rate was 25%, and the accuracy was 90%.	The plasma D-lactate levels in groups 1 and 2 were significantly higher than those in groups 3 and 4 and the control group (𝑃<0.001).	Specificity, sensitivity, PPV, and NPV calculated for D-lactate were as follows: 53%, 80%, 77%, and 57%.
Conclusion	CRP with WBC is useful in distinguishing AA from other diagnoses in the patients. D-Lactate is not a useful laboratory adjunct.	D-lactate may be a useful diagnostic marker for AA.	D-lactat levels may be a useful adjunct to clinical and radiological findings in distinguishing perforated from acute nonperforated AA.	Neither D-lactate concentration nor standard laboratory tests in acute abdomen patients resulted in a better sensitivity for the determination of an indication for acute surgery.	Serum D-lactate had the lowest false negative rate among the other parameters. D-lactate might be a simple and reliable diagnostic marker for AA.	Plasma D-lactate level may be a valuable diagnostic marker for the diagnosis of AA.	Increased D-lactate levels as well as other parameters should be considered as a diagnostic parameter in diagnosis of AA.
Summary and interpretation	D-lactate is not useful in the diagnosis of AA.	D-lactate is useful in the diagnosis of AA.	D-lactate is useful in the diagnosis of AA.	D-lactate is useful in the diagnosis of AA.	D-lactate is useful in the diagnosis of AA.	D-lactate is useful in the diagnosis of AA.	D-lactate is useful in the diagnosis of AA.