Accuracy of citrulline, I-FABP and D-lactate in the diagnosis of acute mesenteric ischemia

Abstract

Early diagnosis of acute mesenteric ischemia (AMI) remains a clinical challenge, and no biomarker has been consistently validated. We aimed to assess the accuracy of three promising circulating biomarkers for diagnosing AMI-citrulline, intestinal fatty acid-binding protein (I-FABP), and D-lactate. A cross-sectional diagnostic study enrolled AMI patients admitted to the intestinal stroke center and controls with acute abdominal pain of another origin. We included 129 patients-50 AMI and 79 controls. Plasma citrulline concentrations were significantly lower in AMI patients compared to the controls [15.3 μmol/L (12.0-26.0) vs. 23.3 μmol/L (18.3-29.8), p = 0.001]. However, the area under the receiver operating curves (AUROC) for the diagnosis of AMI by Citrulline was low: 0.68 (95% confidence interval = 0.58-0.78). No statistical difference was found in plasma I-FABP and plasma D-lactate concentrations between the AMI and control groups, with an AUROC of 0.44, and 0.40, respectively. In this large cross-sectional study, citrulline, I-FABP, and D-lactate failed to differentiate patients with AMI from patients with acute abdominal pain of another origin. Further research should focus on the discovery of new biomarkers.

Figure 1

Flowchart of AMI patients and controls: screening and selection. Abbreviations: AMI acute mesenteric ischemia, CT contrast-enhanced computed tomography.

Figure 2

Citrulline, I-FABP and d-lactate plasma concentrations in AMI patients and controls. Abbreviations: I-FABP intestinal fatty-acid binding protein, AMI acute mesenteric ischemia. Comparison of acute abdominal pain controls (n = 79) and patients with AMI (n = 50). The horizontal line in the boxes represents the median, and the bottom and top of the boxes the 25th and 75th percentiles, respectively. I bars represent the upper adjacent value (75th percentile plus 1.5 times the interquartile range) and the lower adjacent value (corresponding formula below the 25th percentile). Outliers are represented by dots (outside of the I bars) and extreme outliers by asterisks (outside of the 75th percentile plus 3 times the interquartile range, or the 25th percentile minus 3 times the interquartile range).

Figure 3

Citrulline, I-FABP, and d-lactate blood concentrations according to the severity of acute mesenteric ischemia (early or late—necrotic—ischemia). Abbreviations: AMI acute mesenteric ischemia, I-FABP intestinal fatty-acid binding protein. Comparison of acute abdominal pain controls (n = 79) and patients with early AMI (n = 36), and necrotic AMI (n = 14). Analyses were performed with the use of the Kruskal–Wallis test. When the result of a global test was significant (p < 0.05), post hoc Bonferroni-corrected pairwise comparisons were performed. The horizontal line in the boxes represents the median, and the bottom and top of the boxes, the 25th and 75th percentiles, respectively. I bars represent the upper adjacent value (75th percentile plus 1.5 times the interquartile range) and the lower adjacent value (corresponding formula below the 25th percentile). Outliers are represented by dots (outside of the I bars) and extreme outliers by asterisks (outside of the 75th percentile plus 3 times the interquartile range, or the 25th percentile minus 3 times the interquartile range).