Skip to main content
SpringerLink
Log in

Current status on plasma biomarkers for acute mesenteric ischemia

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Clinical diagnosis of acute mesenteric ischemia is difficult. The aim of this review is to provide current status on the search for an accurate plasma biomarker for acute mesenteric ischemia. A search using the medical subject heading terms marker and mesenteric ischemia or intestinal ischemia or superior mesenteric artery occlusion or mesenteric venous thrombosis in the Medline and Embase databases from 1980 to 2011. Studies without a control group or a control group consisted of healthy individuals (human studies), or studies on intestinal reperfusion were excluded. Twenty animal and twelve human studies were identified. In human studies, the studied series of patients had a control group that had a need of laparotomy (n = 2), suspected acute mesenteric ischemia (n = 7), acute abdomen (n = 2) or systemic inflammatory response syndrome (n = 1). d-dimer has been found to be the most consistent highly sensitive early marker, but specificity was low. The follow-up study on α-glutathione S-transferase yielded inferior sensitivity and accuracy than the preliminary study, clearly questioning the value of this marker. Intestinal fatty acid binding globulin (I-FABP) and d-lactate are both interesting markers, but the results were conflicting. Different cut-off levels have been used in the studies on I-FABP. The encouraging preliminary result of cobalt-albumin and urinary FABP as an accurate marker needs to be addressed in other study populations. The early clinical and laboratory diagnosis of intestinal ischemia remains a challenge. None of the proposed plasma-derived tests for acute mesenteric ischemia has as yet entered routine clinical practice. The proposed biomarkers need to be evaluated in a prospective clinical research project in patients with acute abdomen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Acosta S (2010) Epidemiology of mesenteric vascular disease: clinical implications. Semin Vasc Surg 23:4–8

    Article  PubMed  Google Scholar 

  2. Acosta S, Sonesson B, Resch T (2009) Endovascular therapeutic approaches for acute superior mesenteric artery occlusion. Cardiovasc Interv Radiol 32:896–905

    Article  CAS  Google Scholar 

  3. Acosta S, Ögren M, Sternby N-H, Bergqvist D, Björck M (2005) Clinical implications for the management of acute thromboembolic occlusion of the superior mesenteric artery. Autopsy findings in 213 patients. Ann Surg 241:516–522

    Article  PubMed  Google Scholar 

  4. Menke J (2010) Diagnostic accuracy of multidetector CT in acute mesenteric ischemia: systematic review and meta-analysis. Radiology 256:93–101

    Article  PubMed  Google Scholar 

  5. Danielsson Å, Nilsson TK, Uddenfeldt P (1990) Alterations in C1 inhibitor and clotting factor concentrations in primary biliary cirrhosis and other chronic liver diseases. Scand J Gastroenterol 25:149–154

    Article  PubMed  CAS  Google Scholar 

  6. Rifai N, Gerszten RE (2006) Biomarker discovery and validation. Clin Chem 52:1635–1637

    Article  PubMed  CAS  Google Scholar 

  7. Acosta S, Nilsson TK, Bergqvist D, Björck M (2004) Activation of fibrinolysis and coagulation in non-occlusive intestinal ischaemia in a pig model. Blood Coagul Fibrinolysis 15:69–75

    Article  PubMed  CAS  Google Scholar 

  8. Block T, Isaksson HS, Acosta S, Björck M, Brodin D, Nilsson TK (2011) Altered mRNA expression due to acute mesenteric ischemia in a porcine model. Eur J Vasc Endovasc Surg 41:281–287

    Article  PubMed  CAS  Google Scholar 

  9. Acosta S, Nilsson TK, Malina J, Malina M (2007) l-lactate after embolization of the superior mesenteric artery. J Surg Res 143:320–328

    Article  PubMed  CAS  Google Scholar 

  10. Acosta S, Nilsson TK, Björck M (2004) D-dimer testing in patients with suspected acute thromboembolic occlusion of the superior mesenteric artery. Br J Surg 91:991–994

    Article  PubMed  CAS  Google Scholar 

  11. Lange H, Jäckel R (1994) Usefulness of plasma lactate concentration in the diagnosis of acute abdominal disease. Eur J Surg 160:381–384

    PubMed  CAS  Google Scholar 

  12. Arthurs ZM, Titus J, Bannazadeh M, Eagleton MJ, Srivastava S, Sarac TP et al (2011) A comparison of endovascular revascularization with traditional therapy for the treatment of acute mesenteric ischemia. J Vasc Surg 53:698–705

    Article  PubMed  Google Scholar 

  13. Newman TS, Magnuson TH, Ahrendt SA, Smith-Meek MA, Bender JS (1998) The changing face of mesenteric infarction. Ann Surg 64:611–616

    CAS  Google Scholar 

  14. Ritz JP, Germer CT, Buhr HJ (2005) Prognostic factors for mesenteric infarction: multivariate analysis of 187 patients with regard to patient age. Ann Vasc Surg 19:328–334

    Article  PubMed  Google Scholar 

  15. Jakob SM, Merasto-Minkkinen M, Tenkunen JJ, Heino A, Alhava E, Takal J (2000) Prevention of systemic hyperlactaetemia during splanchnic ischemia. Shock 14:123–127

    Article  PubMed  CAS  Google Scholar 

  16. Astles R, Williams CP, Sedor F (1994) Stability of plasma lactate in vitro in the presence of antiglycolytic agents. Clin Chem 40:1327–1330

    PubMed  CAS  Google Scholar 

  17. Acosta S, Nilsson TK, Björck M (2001) Preliminary study of D-dimer as a possible marker of acute bowel ischaemia. Br J Surg 88:385–388

    Article  PubMed  CAS  Google Scholar 

  18. Block T, Nilsson TK, Björck M, Acosta S (2008) Diagnostic accuracy of plasma biomarkers for intestinal ischemia. Scand J Clin Lab Investig 68:242–248

    Article  CAS  Google Scholar 

  19. Chiu YH, Huang MK, How CK, Hsu TF, Chen JD, Chem CH, Yen DH, Huang CI (2009) D-dimer in patients with suspected acute mesenteric ischemia. Am J Emerg Med 27:975–979

    Article  PubMed  Google Scholar 

  20. Block T, Acosta S, Björck M (2010) Endovascular and open surgery for acute occlusion of the superior mesenteric artery. J Vasc Surg 52:959–966

    Article  PubMed  Google Scholar 

  21. Björnsson S, Björck M, Block T, Resch T, Acosta S (2011) Thrombolysis for acute occlusion of the superior mesenteric artery. J Vasc Surg. doi:10.1016/j.jvs.2011.07.054

  22. Acosta S, Alhadad A, Svensson P, Ekberg O (2008) Epidemiology, risk and prognostic factors in mesenteric venous thrombosis. Br J Surg 95:1245–1251

    Article  PubMed  CAS  Google Scholar 

  23. Evennett N, Petrov M, Mittal A, Windsor J (2009) Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia. World J Surg 33:1374–1383

    Article  PubMed  Google Scholar 

  24. Ockner RK, Manning JA (1974) Fatty acid-binding protein in small intestine: identification, isolation, and evidence for its role in cellular fatty acid transport. J Clin Investig 54:326–338

    Article  PubMed  CAS  Google Scholar 

  25. Khurana S, Corbally MT, Manning F, Armenise T, Kierce B, Kilty C (2002) Glutathione S-transferase: a potential new marker of intestinal ischemia. J Pediatr Surg 37:1543–1548

    Article  PubMed  CAS  Google Scholar 

  26. Delaney CP, O’Neill S, Manning F, Fitzpatrick JM, Gorey TF (1999) Plasma concentrations of glutathione S-transferase isoenzyme are raised in patients with intestinal ischemia. Br J Surg 86:1349–1353

    Article  PubMed  CAS  Google Scholar 

  27. Gearhart SL, Delaney CP, Senagore AJ, Banbury MK, Remzi FH, Kiran RP, Fazio VW (2003) Prospective assessment of the predictive value of alpha-glutathione S-transferase for intestinal ischemia. Am Surg 69:1324–1329

    Google Scholar 

  28. Murray MJ, Gonze MD, Nowak LR, Cobb CF (1994) Serum d-(-lactate) levels as an aid to diagnosing acute intestinal ischemia. Am J Surg 167:575–578

    Article  PubMed  CAS  Google Scholar 

  29. Thuijls G, van Wijck K, Grootjans J, Derilix JP, van Bijnen AA, Heineman E, Dejong CH, Buurman WA, Poeze M (2011) Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins. Ann Surg 253:303–308

    Article  PubMed  Google Scholar 

  30. Kanda T, Fujii H, Tani T, Murakami H, Suda T, Sakai Y, Ono T, Hatakeyama K (1996) Intestinal fatty acid-binding protein is a useful diagnostic marker for mesenteric infarction in humans. Gastroenterology 110:339–343

    Article  PubMed  CAS  Google Scholar 

  31. Lieberman Jm, Sacchettin J, Marks C, Mark WH (1997) Human intestinal fatty acid binding protein: report of an assay with studies in normal volunteers and intestinal ischemia. Surgery 121:335–342

    Article  PubMed  CAS  Google Scholar 

  32. Bhardwaj A, Truong QA, Peacock WF, Yeo KT, Storrow A, Thomas F, Curtis KM, Foote RS, Lee HK, Miller KF, Januzzi JLJ (2011) A multicenter comparison of established and emerging cardiac biomarkers for the diagnostic evaluation of chest pain in the emergency department. Am Heart J 162:276–282

    Article  PubMed  Google Scholar 

  33. Baker JO, Reinhold J, Redwood S, Marber MS (2011) Troponins: redefining their limits. Heart 97:447–452

    Article  PubMed  Google Scholar 

  34. Andersen AM, Novovic S, Ersböll AM, Jorgensen LN, Hansen MB (2010) Urinary trypsinogen-2 dipstick in acute pancreatitis. Pancreas 39:26–30

    Article  PubMed  Google Scholar 

  35. Sutton PA, Humes DJ, Purcell G, Smith JK, Whiting F, Wright T, Morgan L, Lobo DN (2009) The role of routine assays of serum amylase and lipase for the diagnosis of acute abdominal pain. Ann R Coll Surg Engl 91:381–384

    Article  PubMed  Google Scholar 

  36. Smith RC, Southwell-Kelly J, Chesher D (2005) Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis? ANZ J Surg 75:399–404

    Article  PubMed  Google Scholar 

  37. Acosta S, Block T, Björnsson S, Resch T, Björck M, Nilsson TK (2011) Diagnostic pitfalls at admission in patients with acute superior mesenteric artery occlusion. J Emerg Med (accepted)

  38. Nielsen C, Lindholt JS, Erlandsen EJ, Mortensen FV (2011) D-lactate as a marker of venous-induced intestinal ischemia: an experimental study in pigs. Int J Surg 9:428–432

    Article  PubMed  Google Scholar 

  39. Talasniemi JP, Pennanen S, Savolainen H, Niskanen L, Liesivuori J (2008) Analytical investigation: assay of d-lactate in diabetic plasma and urine. Clin Biochem 41:1099–1103

    Article  PubMed  CAS  Google Scholar 

  40. Nielsen C, Pedersen LT, Lindholt JS, Mortensen FV, Erlandsen EJ (2011) An automated plasma d-lactate assay with a new sample preparation method to prevent interference from l-lactate and l-lactate dehydrogenase. Scand J Clin Lab Investig 71:507–514

    Article  CAS  Google Scholar 

  41. Dempfle CE, Zips S, Ergul H, Heene DL, The Fibrin Assay Comparative Trial Study Group (2001) The Fibrin Assay Comparison Trial (FACT): evaluation of 23 quantitative d-dimer assays as basis for the development of d-dimer calibrators. Thromb Haemost 85:671–678

    PubMed  CAS  Google Scholar 

  42. Edlund B, Nilsson TK (2006) A proposed stoichiometrical calibration procedure to achieve transferability of d-dimer measurements and to characterize the performance of different methods. Clin Biochem 39:137–142

    Article  PubMed  CAS  Google Scholar 

  43. Lobe TE, Schwartz MZ, Rickardson CJ, Rassin DK, Gourley WK, Srivastava SK, Storozuk RB (1983) Hexosaminidase: a marker for intestinal gangrene in necrotizing enterocolitis. J Pediatr Surg 18:449–452

    Article  PubMed  CAS  Google Scholar 

  44. Graeber GM, Wolf RE, Harmon JW (1984) Serum creatine kinase and alkaline phosphatase in experimental small bowel infarction. J Surg Res 37:25–32

    Article  PubMed  CAS  Google Scholar 

  45. Thompson JS, Bragg LE, West WW (1990) Serum enzyme levels during intestinal ischemia. Ann Surg 211:369–373

    Article  PubMed  CAS  Google Scholar 

  46. Kanda T, Nakatomi Y, Ishikawa H, Hiltomi M, Matsubara Y, Ono T, Mato T (1992) Intestinal fatty acid-binding protein as a sensitive marker of intestinal ischemia. Dig Dis Sci 37:1362–1367

    Article  PubMed  CAS  Google Scholar 

  47. Murray MJ, Barbose JJ, Cobb CF (1993) Serum d-(-lactate) levels as a predictor of acute intestinal ischemia in a rat model. J Surg Res 54:507–509

    Article  PubMed  CAS  Google Scholar 

  48. Morris S, Hays W, Enomoto M, Glew R, Feddersen R, Donald F, Morris D (1999) Serum cytosolic β-glucosidase elevation and early ischemic injury to guinea pig small intestine. Surgery 125:202–210

    Article  PubMed  CAS  Google Scholar 

  49. Dimmitt RA, Glew R, Colby C, Brindle M, Skarsgaard E, Moss RL (2003) Serum cytosolic β-glucosidase activity in a rat model of necrotizing enterocolitis. Pediatr Res 54:462–465

    Article  PubMed  CAS  Google Scholar 

  50. Niewold TA, Meinen M, van der Meulen J (2004) Plasma intestinal fatty acid binding protein (I-FABP) concentrations increase following intestinal ischemia in pigs. Res Vet Sci 77:89–91

    Article  PubMed  CAS  Google Scholar 

  51. Gumaste UR, Joshi MM, Mourya DT, Barde PV, Shrivastav GK, Ghote VS (2005) Alcohol dehydrogenase: a potential new marker for diagnosis of intestinal ischemia using rat as a model. World J Gastroenterol 14:912–916

    Google Scholar 

  52. Kulacoglu H, Kocaerkek Z, Moran M, Kulak B, Atay C, Kulacoglu S, Ozmen M, Coskun F (2005) Diagnostic value of blood d-dimer level in acute mesenteric ischemia in the rat: an experimental study. Asian J Surg 28:131–135

    Article  PubMed  Google Scholar 

  53. Altinyollar H, Boyabatli M, Berberoglu U (2006) d-dimer as a marker for early diagnosis of acute mesenteric ischemia. Thromb Res 117:463–467

    Article  PubMed  CAS  Google Scholar 

  54. Wang JY, Cheng KI, Yu FJ, Tsai HL, Huang TJ, Hsieh JS (2006) Analysis of the correlation of plasma NO and ET-1 levels in rats with acute mesenteric ischemia. J Investig Surg 19:155–161

    Article  Google Scholar 

  55. Gunerhan Y, Koksal N, Kayahan M, Eryavuz Y, Sekban H (2008) Diagnostic value of plasminogen activity in acute mesenteric ischemia. World J Gastroenterol 14:2540–2543

    Article  PubMed  Google Scholar 

  56. Dundar ZD, Cander B, Gul M, Karabulut KU, Kocak S, Girisgin S, Mehmetoglu I, Toy H (2011) Serum intestinal fatty acid binding protein and phosphate levels in the diagnosis of acute intestinal ischemia: an experimental study in rabbits. J Emerg Med. doi:10.1016/j.jemermed.2011.05.051

  57. Dundar ZD, Cander B, Gul M, Karabulut KU, Grisgin S (2010) Serum-ischemia-modified albumin levels in an experimental acute mesenteric ischemia model. Acad Emerg Med 17:1233–1238

    Article  PubMed  Google Scholar 

  58. Uygun M, Yilmaz S, Pekdemir M, Duman C, Gürbüz YS (2011) The diagnostic value of ischemia-modified albumin in a rat model of acute mesenteric ischemia. Acad Emerg Med 18:355–359

    Article  PubMed  Google Scholar 

  59. Zhang FX, Mo BB, Liang GZ, Zhang H (2011) Analysis of serum enzyme levels in a rabbit model of acute mesenteric ischemia. J Mol Med Report 4:1095–1099

    CAS  Google Scholar 

  60. Polk JD, Rael LT, Craun ML, Mains CW, Davis-Merritt D, Bar-Or D (2008) Clinical utility of the cobalt-albumin binding assay in the diagnosis of intestinal ischemia. J Trauma 64:42–45

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Vascular Center, Skåne University Hospital, Malmö, Sweden

    Stefan Acosta

  2. Department of Clinical Chemistry, Örebro University Hospital, Örebro, Sweden

    Torbjörn Nilsson

Authors
  1. Stefan Acosta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Torbjörn Nilsson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stefan Acosta.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Acosta, S., Nilsson, T. Current status on plasma biomarkers for acute mesenteric ischemia. J Thromb Thrombolysis 33, 355–361 (2012). https://doi.org/10.1007/s11239-011-0660-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-011-0660-z

Keywords

Search

Navigation