Abstract
Background
Intestinal ischemia is a potentially catastrophic abdominal emergency that presents a significant diagnostic challenge in the critical care setting. We performed a systematic review of the literature to define the diagnostic accuracy of serological markers of intestinal ischemia.
Methods
Observational studies on the performance of markers of intestinal ischemia were identified within the MEDLINE and EMBASE electronic databases. All studies from which it was possible to derive true positive, false positive, false negative, and true negative results were included. A random-effects model was used to calculate the pooled estimates of diagnostic accuracy.
Results
A total of 20 articles examining 18 different serological markers were identified that met the inclusion criteria. The global measures of test performance (diagnostic odds ratio and area under the summary receiver operating characteristic curve) for markers investigated in three or more studies were d-lactate (10.75 and 0.86, respectively), glutathione S-transferase (GST; 8.82 and 0.87, respectively), intestinal fatty-acid binding protein (i-FABP; 7.62 and 0.78, respectively), and d-dimer (5.77 and 0.53, respectively).
Conclusions
The performance of the currently available serological markers is suboptimal for routine clinical use, but novel markers of intestinal ischemia such as d-lactate, GST, and i-FABP may offer improved diagnostic accuracy. The early diagnosis of intestinal ischemia remains a challenge, and further research is required to identify improved serological markers and to demonstrate their clinical utility in the individual patient.
Similar content being viewed by others
References
Kairaluoma MI, Karkola P, Heikkinen D et al (1977) Mesenteric infarction. Am J Surg 133:188–193
Martin B (2007) Prevention of gastrointestinal complications in the critically ill patient. AACN Adv Crit Care 18:158–166
Reilly PM, Wilkins KB, Fuh KC et al (2001) The mesenteric hemodynamic response to circulatory shock: an overview. Shock 15:329–343
Ceppa EP, Fuh KC, Bulkley GB (2003) Mesenteric hemodynamic response to circulatory shock. Curr Opin Crit Care 9:127–132
De Backer D, Creteur J, Silva E et al (2003) Effects of dopamine, norepinephrine, and epinephrine on the splanchnic circulation in septic shock: which is best? Crit Care Med 31:1659–1667
Lundberg J, Lundberg D, Norgren L et al (1990) Intestinal hemodynamics during laparotomy: effects of thoracic epidural anesthesia and dopamine in humans. Anesth Analg 71:9–15
van der Voort PH (2006) The incomplete puzzle of vasoactive medication in (abdominal) sepsis. Crit Care Med 34:1565–1566
Woo K, Major K, Kohanzadeh S et al (2007) Laparotomy for visceral ischemia and gangrene. Am Surg 73:1006–1008
Kougias P, Lau D, El Sayed HF et al (2007) Determinants of mortality and treatment outcome following surgical interventions for acute mesenteric ischaemia. J Vasc Surg 46:467–474
Angelelli G, Scardapane A, Memeo M et al (2004) Acute bowel ischaemia: CT findings. Eur J Radiol 50:37–47
Kozuch PL, Brandt LJ (2005) Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 21:201–215
Furukawa A, Kanasaki S, Kono N et al (2009) CT diagnosis of acute mesenteric ischemia from various causes. AJR Am J Roentgenol 192:408–416
Brandt LJ, Boley SJ (2000) AGA technical review on intestinal ischemia. American Gastrointestinal Association. Gastroenterology 118:954–968
Glenister KM, Corke CF (2004) Infarcted intestine: a diagnostic void. Aust N Z J Surg 74:260–265
Oldenburg WA, Lau LL, Rodenberg TJ et al (2004) Acute mesenteric ischaemia: a clinical review. Arch Intern Med 164:1054–1062
Whiting P, Rutjes AW, Reitsma JB et al (2003) The development of QUADAS: a tool for the quality assessment of studies of diagnostic accuracy included in systematic reviews. BMC Med Res Methodol 10:25
Zamora J, Abraira V, Muriel A et al (2006) Meta-DiSc: a software for meta-analysis of test accuracy data. BMC Med Res Methodol 12:31
DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188
Moses LE, Shapiro D, Littenberg B (1993) Combining independent studies of a diagnostic test into a summary ROC curve: data-analytic approaches and some additional considerations. Stat Med 12:1293–1316
Walter SD (2002) Properties of the summary receiver operating characteristic (SROC) curve for diagnostic test data. Stat Med 21:1237–1256
TS Higgins JP, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560
Acosta S, Nilsson TK, Bjorck M (2004) d-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery. Br J Surg 91:991–994
Block T, Nilsson TK, Bjorck M et al (2008) Diagnostic accuracy of plasma biomarkers for intestinal ischaemia. Scand J Clin Lab Invest 68:242–248
Delaney CP, O’Neill S, Manning F et al (1999) Plasma concentrations of glutathione S-transferase isoenzyme are raised in patients with intestinal ischaemia. Br J Surg 86:1349–1353
Feretis CB, Koborozos BA, Vyssoulis GP et al (1985) Serum phosphate levels in acute bowel ischemia. An aid to early diagnosis. Am Surg 51:242–244
Fried MW, Murthy UK, Hassig SR et al (1991) Creatine kinase isoenzymes in the diagnosis of intestinal infarction. Dig Dis Sci 36:1589–1593
Icoz G, Makay O, Sozbilen M et al (2006) Is d-dimer a predictor of strangulated intestinal hernia? World J Surg 30:2165–2169
Kanda T, Fujii H, Tani T et al (1996) Intestinal fatty acid-binding protein is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology 110:339–343
Lange H (1989) Differential diagnostic significance of lactate in acute abdominal diseases. Chirurg 60:356–360
Lange H, Toivola A (1997) Warning signals in acute abdominal disorders. Lactate is the best marker of mesenteric ischemia. Lakartidningen 94:1893–1896
Leo PJ, Simonian HG (1996) The role of serum phosphate level and acute ischemic bowel disease. Am J Emerg Med 14:377–379
Murray MJ, Gonze MD, Nowak LR et al (1994) Serum d(–)-lactate levels as an aid to diagnosing acute intestinal ischemia. Am J Surg 167:575–578
Sutherland F, Cunningham H, Pontikes L et al (2003) Elevated serum interleukin 6 levels in patients with acute intestinal ischemia. Hepatogastroenterology 50:419–421
Acosta S, Bjorck M (2003) Acute thrombo-embolic occlusion of the superior mesenteric artery: a prospective study in a well defined population. Eur J Vasc Endovasc Surg 26:179–183
Gearhart SL, Delaney CP, Senagore AJ et al (2003) Prospective assessment of the predictive value of alpha-glutathione S-transferase for intestinal ischemia. Am Surg 69:324–329 discussion 329
Lieberman JM, Sacchettini J, Marks C et al (1997) Human intestinal fatty acid binding protein: report of an assay with studies in normal volunteers and intestinal ischemia. Surgery 121:335–342
Assadian A, Assadian O, Senekowitsch C et al (2006) Plasma d-lactate as a potential early marker for colon ischaemia after open aortic reconstruction. Eur J Vasc Endovasc Surg 31:470–474
Graeber GM, Clagett GP, Wolf RE et al (1990) Alterations in serum creatine kinase and lactate dehydrogenase. Association with abdominal aortic surgery, myocardial infarction and bowel necrosis. Chest 97:521–527
Poeze M, Froon AH, Greve JW et al (1998) d-lactate as an early marker of intestinal ischaemia after ruptured abdominal aortic aneurysm repair. Br J Surg 85:1221–1224
Cronk DR, Houseworth TP, Cuadrado DG et al (2006) Intestinal fatty acid binding protein (i-FABP) for the detection of strangulated mechanical small bowel obstruction. Curr Surg 63:322–325
Polk JD, Rael LT, Craun ML et al (2008) Clinical utility of the cobalt-albumin binding assay in the diagnosis of intestinal ischemia. J Trauma 64:42–45
Deville WL, Buntinx F, Bouter LM et al (2002) Conducting systematic reviews of diagnostic studies: didactic guidelines. BMC Med Res Methodol 2:9
Deitch EA, Morrison J, Berg R et al (1990) Effect of hemorrhagic shock on bacterial translocation, intestinal morphology, and intestinal permeability in conventional and antibiotic-decontaminated rats. Crit Care Med 18:529–536
Lee ES, Bass A, Arko FR et al (2006) Intraoperative colon mucosal oxygen saturation during aortic surgery. J Surg Res 136:19–24
Besselink MG, van Santvoort HC, Buskens E et al (2008) Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial. Lancet 371:651–659
Mofidi R, Deans C, Duff MD et al (2006) Prediction of survival from carcinoma of oesophagus and oesophago-gastric junction following surgical resection using an artificial neural network. Eur J Surg Oncol 32:533–539
Acknowledgments
Dr. Petrov is Kenneth Warren Fellow of the International Hepato-Pancreato-Biliary Association (IHPBA). The authors are grateful to Dr. Michael Gillham (Auckland City Hospital, Auckland, New Zealand) for critically reviewing the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Evennett, N.J., Petrov, M.S., Mittal, A. et al. Systematic Review and Pooled Estimates for the Diagnostic Accuracy of Serological Markers for Intestinal Ischemia. World J Surg 33, 1374–1383 (2009). https://doi.org/10.1007/s00268-009-0074-7
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-009-0074-7