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.