Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis

Abstract

Background Acute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans. Methods A systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers’ sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool. Results Seventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses. Conclusions None of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.

Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study)

“…Although this finding was partially expected, it is important because in existing literature SBO (with the extent of gangrene commonly not specified) is often bundled as AMI. In a recent systematic review on biomarkers of AMI, the majority of studies investigating AMI included patients with SBO, complicating interpretation of results [ 19 ]. To our knowledge, our study is one of the first that separates these entities and allows for some rough comparisons of data beyond just blood lactate values [ 20 ].…”

“…Previous observations have shown that clinical characteristics and laboratory tests are unable to clearly distinguish between patients with and without AMI [ 19 , 21 ]. This study revealed differences that can be explored in more detail in the future through an attempt to construct a prediction model.…”

Portal venous contrast enhancement ratio of the adrenal glands and spleen as prognostic marker of mortality in patients with acute mesenteric ischemia

“…Another recent study investigated the prognostic relevance of CT-defined body composition parameters in patients with AMI to extract novel prognostic markers from the CT images [ 13 ]. This is especially of importance as even established laboratory parameters comprising lactate, D-dimers, C-reactive protein, and white blood cell count have low accuracy to predict a poor clinical outcome in these patients [ 14 ].…”

Association between hemostasis and acute mesenteric ischemia: a Mendelian randomization analysis

“…D-dimer is a marker of activation of coagulation and brinolysis and is investigated as a biomarker of AMI. But its diagnostic accuracy is still controversial and there is currently a lack of de nite biomarkers for accurate diagnosis of AMI [7]. Anticoagulation and thrombolysis treatments are used in several subtypes of AMI patients but their effects have not been evaluated or con rmed by high-quality trials [1][2][3].…”