İbrahim DOĞAN, Serhat OCAKLI, Fırat CANLIKARAKAYA, Cengiz CEYLAN
Turkish Journal of Surgery - 2026;42(2):167-172
Objective: Acute mesenteric ischemia (AMI) is a life-threatening condition characterized by rapid deterioration, yet it is often identified late owing to vague and non-specific clinical findings. Identifying laboratory markers that can assist in early mortality prediction remains essential for improving outcomes. This study aimed to determine whether the bicarbonate-to-lactate ratio (HCO?/lactate) and the albumin-to-creatinine ratio could serve as reliable predictors of early mortality in patients with AMI. Material and Methods: This retrospective case-control study included 87 patients who underwent surgical treatment for acute arterial mesenteric ischemia caused by superior mesenteric artery embolism between 2015 and 2025. Demographic characteristics, comorbidities, laboratory findings, and mortality outcomes were evaluated. The predictive performance of the bicarbonate-to-lactate and albumin-to-creatinine ratios was assessed using receiver operating characteristic (ROC) analysis; independent predictors of mortality were identified through multivariate logistic regression. Results: The 28-day mortality rate was 62.1%. In univariate analysis, lower bicarbonate and albumin levels, reduced HCO?/lactate and albumin/creatinine ratios, and higher lactate, creatinine, and C-reactive protein values were significantly associated with mortality (p<0.05). ROC analysis identified values of <6 for the HCO?/lactate ratio and <2.6 for the albumin/creatinine ratio as the best cut-off values. In the multivariate model, a HCO?/lactate ratio <6 increased the risk of death by more than 13-fold, while an albumin/creatinine ratio <2.6 increased mortality risk by approximately 4.5-fold. Conclusion: Both the HCO?/lactate and albumin/creatinine ratios are simple, inexpensive, and easily obtainable biochemical markers that may assist clinicians in predicting early mortality in AMI. Their incorporation into early evaluation algorithms could enhance risk stratification, although validation through prospective studies is warranted.
