Accuracy of citrulline, I-FABP and d-lactate in the diagnosis of acute mesenteric ischemia
Authors: Nuzzo Alexandre , Guedj Kevin , Curac Sonja , Hercend Claude , Bendavid Claude , Gault Nathalie , Tran-Dinh Alexy , Ronot Maxime , Nicoletti Antonino , Bouhnik Yoram , Castier Yves , Corcos Olivier , Peoc’h Katell ,   The SURVI (Structure d’URgences Vasculaires Intestinales) Research Group (French Intestinal Stroke Center), Huguet Audrey , Stefanescu Carmen , Treton Xavier , Joly Francisca , Billiauws Lore , Hamon Annick , Boitet Aureline , Lekhal Céline , Deutsch David , Oiknin Elsa , Cohen Laura , Marcellier Gabriel , Senemaud Jean , Corre Felix , Soudan Damien , Voican Cosmin , Leclère Jean-Baptiste , Iquilles Jules , Raynaud Lucas , Paulatto Luisa , Haas Manon , Uzzan Mathieu , Cohen Mathilde , Tadbiri Sara , Prevot Servane , Panis Yves , Frontali Alice , Msika Simon , Ribeiro Lara , Rebibo Lionel , Arapis Konstantinos , Orville Marion , Sibert Annie , Copin Pauline , Zappa Magaly , Dioguardi Burgio Marco , Vilgrain Valérie , Bertin Caroline , Kerbaol Anne , Allaham Wassim , Pellenc Quentin , Roussel Arnaud , Cerceau Pierre , Ben Abdallah Iannis , Girault Antoine , Mordant Pierre , De Blic Romain , Paugam Catherine , Weiss Emmanuel , Abback Paer-Selim , Enriquez Isabelle , Janny Sylvie , Bout Helene , Giabicani Mikhael , Achouf Marina , Grigoresco Bénédicte , Ear Linda Koy , Curac Sonja , Cachier Agnès , Plessier Aurelie , Rautou Pierre-Emmanuel , Valla Dominique , Payancé Audrey , Sauvanet Alain , Dokmak Safi , Dondero Federica , Sepulveda Ailton , Farges Olivier , Aussilhou Beatrice , Jais Bénédicte , Cazals-Hatem Dominique , De Raucourt Emmanuelle , Boudaoud Larbi , Trichet Catherine , Puy Herve , Pons-Kerjean Nathalie , Stocco Jeanick , Bataille Julie , Bouton Valérie , Montravers Philippe , Augustin Pascal , Lortat Jacob Brice , Michel Jean-Baptiste , Gauguier Dominique , Dumas Marc-Emmanuel , Brial François , Myridakis Antonis , Martinez-Gili Laura , Olanipekun Michael , Marcault Estelle , Nilusmas Cindie , Barnier Anne , Souare Aminata 
Published: September 2021

Early diagnosis of acute mesenteric ischemia (AMI) remains a clinical challenge, and no biomarker has been consistently validated. We aimed to assess the accuracy of three promising circulating biomarkers for diagnosing AMI—citrulline, intestinal fatty acid-binding protein (I-FABP), and d-lactate. A cross-sectional diagnostic study enrolled AMI patients admitted to the intestinal stroke center and controls with acute abdominal pain of another origin. We included 129 patients—50 AMI and 79 controls. Plasma citrulline concentrations were significantly lower in AMI patients compared to the controls [15.3 μmol/L (12.0–26.0) vs. 23.3 μmol/L (18.3–29.8), p = 0.001]. However, the area under the receiver operating curves (AUROC) for the diagnosis of AMI by Citrulline was low: 0.68 (95% confidence interval = 0.58–0.78). No statistical difference was found in plasma I-FABP and plasma d-lactate concentrations between the AMI and control groups, with an AUROC of 0.44, and 0.40, respectively. In this large cross-sectional study, citrulline, I-FABP, and d-lactate failed to differentiate patients with AMI from patients with acute abdominal pain of another origin. Further research should focus on the discovery of new biomarkers.