title: Plasma citrulline measurement in the diagnosis of acute mesenteric ischaemia.
abstract: BACKGROUND
  The differential diagnosis in acute mesenteric ischaemia (AMI) is essential and sometimes life-saving. A marker for early diagnosis is lacking. Citrulline is an amino acid mainly synthesized by small bowel enterocytes from glutamine. In this study, we aimed to evaluate the diagnostic and prognostic values of citrulline with those of the D-dimer in patients with AMI.
  
  
  METHODS
  The patients were divided into two groups; group 1: patients with acute abdominal findings which were attributed preoperatively to AMI, and group 2: patients with acute abdominal findings which were attributed preoperatively to causes other than AMI. All patients underwent surgical exploration. Blood samples were taken before surgery. The demographic features, laboratory examinations, citrulline concentration, D-dimer level and surgical findings were evaluated.
  
  
  RESULTS
  Overall, 48 patients were enrolled in the study. AMI was diagnosed in 23 of the 48 patients. There was no significant difference between the groups with regard to gender, leucocyte count and creatinine levels but group 1 was significantly older than group 2. Citrulline, D-dimer and lactate levels were also significantly higher in group 1. Age, lactate, D-dimer and citrulline levels were statistically significant for mortality. The most significant factor was increased lactate level at admission.
  
  
  CONCLUSIONS
  Plasma citrulline level may be helpful in the diagnosis of patients with AMI.
authors.affiliation: Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Rıdvan
authors.initials: R
authors.lastname: Kulu
authors.affiliation: Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Hizir
authors.initials: H
authors.lastname: Akyildiz
authors.affiliation: Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Alper
authors.initials: A
authors.lastname: Akcan
authors.affiliation: Department of Biostatistics, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Oztürk
authors.affiliation: Department of General Surgery, School of Medicine, Erciyes University, Kayseri, Turkey.
authors.forename: Erdogan
authors.initials: E
authors.lastname: Sozuer
mesh_terms: D000208:Acute Disease; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002956:Citrulline / Q000097:blood*; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000175:diagnosis* / Q000378:metabolism* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002956:Citrulline
keywords: acute mesenteric ischaemia; citrulline