Systematicreview and pooled estimates for the diagnostic accuracy of serological markers for intestinal ischemia

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. © 2009 Société Internationale de Chirurgie.