Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis

Abstract

Laparotomy remains the gold standard for diagnosis of acute mesenteric ischemia (AMI), but is often unhelpful or too late due to non-specific clinical and radiological signs. This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of the novel serological biomarkers intestinal fatty acid-binding protein (I-FABP), α-glutathione S-transferase (α-GST), D-lactate, ischemia modified albumin (IMA), and citrulline to detect AMI. A systematic search of electronic databases was performed to identify all published diagnostic accuracy studies on I-FABP, α-GST, D-lactate, IMA, and citrulline. Articles were selected based on pre-defined inclusion and exclusion criteria. Risk of bias and applicability were assessed. Two-by-two contingency tables were constructed to calculate accuracy standards. Summary estimates were computed using random-effects models. The search yielded 1925 papers, 21 were included in the final analysis. Pooled sensitivity and specificity for investigated biomarkers were: I-FABP (Uden); 79.0 (95% CI 66.5-88.5) and 91.3 (87.0-94.6), I-FABP (Osaka); 75.0 (67.9-81.2) and 79.2 (76.2-82.0), D-lactate; 71.7 (58.6-82.5) and 74.2 (69.0-79.0), α-GST; 67.8 (54.2-79.5) and 84.2 (75.3-90.9), IMA; 94.7 (74.0-99.9) and 86.4 (65.1-97.1), respectively. One study investigated accuracy standards for citrulline: sensitivity 39% and specificity 100%. The novel serological biomarkers I-FABP, α-GST, IMA, and citrulline may offer improved diagnostic accuracy of acute mesenteric ischemia; however, further research is required to specify threshold values and accuracy standards for different aetiological forms.

Keywords: Acute abdomen; Acute mesenteric ischemia; Biomarker; Citrulline; D-Lactate; Diagnostic accuracy; Glutathione S-transferases; Intestinal fatty acid-binding protein; Ischemia modified albumin; Non-occlusive mesenteric ischemia.

Fig. 1

Search strategy and flow chart. Some authors investigated multiple biomarkers

Fig. 2

Forest plots and SROC curve of I-FABP (Uden kit) to detect acute mesenteric ischemia. SROC summary receiver-operating characteristic, AUC area under curve, SE sensitivity

Fig. 3

Forest plots and SROC curve of I-FABP (Osaka kit) to detect acute mesenteric ischemia. SROC summary receiver-operating characteristic, AUC area under curve, SE sensitivity

Fig. 4

Forest plots and SROC curve of d-lactate to detect acute mesenteric ischemia. SROC summary receiver-operating characteristic, AUC area under curve, SE sensitivity

Fig. 5

Forest plots and SROC curve of alpha-GST to detect acute mesenteric ischemia. SROC summary receiver-operating characteristic, AUC area under curve, SE sensitivity

Fig. 6

Forest plots and SROC curve of IMA to detect acute mesenteric ischemia