Systematic review and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia.
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.
Department of Surgery, Institute of Child Health, London, UK. nevennett@mac.com
Nicholas J
NJ
Evennett
Maxim S
MS
Petrov
Anubhav
A
Mittal
John A
JA
Windsor
D000681:Amylases / Q000097:blood; D015415:Biomarkers / Q000097:blood*; D042241:Early Diagnosis; D005260:Female; D005982:Glutathione Transferase / Q000097:blood; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000097:blood / Q000175:diagnosis*; D019344:Lactic Acid / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity; D012698:Serologic Tests / Q000379:methods*
D015415:Biomarkers; D019344:Lactic Acid; D005982:Glutathione Transferase; D000681:Amylases