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.

Prognostic Factors for Mortality in Acute Mesenteric Ischemia

“…In both multivariable models, the importance of lactate as a predictor of poor outcome was outlined. Although lactate levels have certain limitations for diagnosis purposes [7,8,18,19], an association between elevated lactate and inferior outcomes was described previously [11,20]. Here, we could demonstrate that postoperative mortality changes disproportionately with an increase in preoperative lactate levels (Table 4).…”

“…In a further meta-analysis form 2017, D-lactate, produced due to bacterial fermentation, had a pooled sensitivity of 71.7%, but a specificity of 74.2% [19]. However, Nuzzo et al showed, in a cross-sectional study from 2021, that D-lactate is not suitable for the differentiation of patients with AMI from patients with other acute abdominal pathologies [7]. In our cohort, lactate was measured preoperatively via venous blood gas analysis.…”

“…protein and citrulline as three of the most promising biomarkers for early-stage AMI failed to distinguish patients with AMI from patients with acute abdominal pain of another origin [7]. The prevention and early diagnosis of AMI (e.g., through novel biomarkers and composite risk-assessment scores) seem to be of fundamental importance to improve outcomes in these patients and should be the focus of further research.…”

“…While a rapid diagnosis and subsequent treatment result in distinctively better outcomes [4,5], the overall mortality rates are high in comparison to other surgical emergencies [6]. Therefore, patients suspected of AMI should be diagnosed and treated with high priority to achieve acceptable outcomes [5,7]. Unfortunately, the lack of specific parameters and often vague early clinical symptoms frequently result in a notable delay in diagnostic measures and targeted treatment [8].…”

Prognostic factors in patients with acute mesenteric ischemia—novel tools for determining patient outcomes

“…Unfortunately, the value of clinical, biochemical, and radiological parameters is often limited due to a lack of diagnostic accuracy [5,6]. Laboratory parameters such as D-dimers, c-reactive protein (CRP), leucocytes or lactate have limited specificity to aid in diagnosis [7][8][9][10][11][12]. Other parameters such as citrulline or intestinal fatty acid binding protein (I-FABP) with so far good discrimination in small patient series have not arrived in clinical practice yet [13].…”