Acute mesenteric ischaemia (AMI) is a disease with different pathophysiological mechanisms, leading to a life-threatening condition that is difficult to diagnose based solely on clinical signs. Despite widely acknowledged need for biomarkers in diagnosis of AMI, a broad systematic review on all studied biomarkers in different types of AMI is currently lacking. The aim of this study was to estimate the diagnostic accuracy of all potential biomarkers of AMI studied in humans. A systematic literature search in PubMed, The Cochrane Library, Web of Science and Scopus was conducted in December 2022. Studies assessing potential biomarkers of AMI in (at least 10) adult patients and reporting their diagnostic accuracy were included. Meta-analyses of biomarkers’ sensitivity, specificity, and positive and negative likelihood ratios were conducted. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study quality was assessed with the QUADAS-2 tool. Seventy-five studies including a total of 9914 patients assessed 18 different biomarkers in serum/plasma and one in urine (each reported in at least two studies), which were included in meta-analyses. None of the biomarkers reached a conclusive level for accurate prediction. The best predictive value overall (all studies with any type and stage of AMI pooled) was observed for Ischaemia-modified albumin (2 studies, sensitivity 94.7 and specificity 90.5), interleukin-6 (n = 4, 96.3 and 82.6), procalcitonin (n = 6, 80.1 and 86.7), and intestinal fatty acid-binding protein (I-FABP) measured in serum (n = 16, 73.9 and 90.5) or in urine (n = 4, 87.9 and 78.9). In assessment of transmural mesenteric ischaemia, urinary I-FABP (n = 2, 92.3 and 85.2) and D-dimer (n = 3, 87.6 and 83.6) showed moderate predictive value. Overall risk of bias was high, mainly because of selected study populations and unclear timings of the biomarker measurements after onset of symptoms. Combinations of biomarkers were rarely studied, not allowing meta-analyses. None of the studied biomarkers had sufficient sensitivity and specificity to diagnose AMI, although some biomarkers showed moderate predictive accuracy. Future studies should focus on timing of measurements of biomarkers, distinguishing between early stage and transmural necrosis, and between different types of AMI. Additionally, studies on combinations of biomarkers are warranted. PROSPERO registration: CRD42022379341.

中文翻译：

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检测成人患者急性肠系膜缺血的生物标志物的诊断准确性：系统评价和荟萃分析

急性肠系膜缺血（AMI）是一种具有不同病理生理机制的疾病，会导致危及生命的病症，仅根据临床症状很难诊断。尽管人们普遍认为诊断 AMI 需要生物标志物，但目前缺乏对不同类型 AMI 中所有研究的生物标志物的广泛系统评价。本研究的目的是评估在人类中研究的所有潜在 AMI 生物标志物的诊断准确性。2022 年 12 月在 PubMed、Cochrane 图书馆、Web of Science 和 Scopus 中进行了系统文献检索。其中包括评估（至少 10 名）成年患者的 AMI 潜在生物标志物并报告其诊断准确性的研究。对生物标志物的敏感性、特异性以及阳性和阴性似然比进行荟萃分析。遵循系统评价和荟萃分析的首选报告项目 (PRISMA) 指南，并使用 QUADAS-2 工具评估研究质量。包括总共 9914 名患者在内的 75 项研究评估了血清/血浆中的 18 种不同生物标志物和尿液中的一种生物标志物（每项均在至少两项研究中报告），这些生物标志物均纳入荟萃分析。没有一个生物标志物达到准确预测的结论性水平。总体而言，最佳预测值（所有 AMI 类型和阶段的研究汇总）观察到缺血修饰白蛋白（2 项研究，敏感性 94.7 和特异性 90.5）、白细胞介素 6（n = 4、96.3 和 82.6）、降钙素原（n = 4、96.3 和 82.6）。 n = 6、80.1 和 86.7），以及血清（n = 16、73.9 和 90.5）或尿液（n = 4、87.9 和 78.9）中测量的肠脂肪酸结合蛋白（I-FABP）。在评估透壁肠系膜缺血时，尿 I-FABP（n = 2、92.3 和 85.2）和 D-二聚体（n = 3、87.6 和 83.6）显示出中等预测价值。总体偏倚风险很高，主要是因为选定的研究人群以及症状出现后生物标志物测量的时间不明确。生物标志物的组合很少被研究，不允许进行荟萃分析。尽管一些生物标志物显示出中等的预测准确性，但所研究的生物标志物均没有足够的敏感性和特异性来诊断 AMI。未来的研究应侧重于生物标志物测量的时机、区分早期和透壁坏死以及不同类型的 AMI。此外，有必要对生物标志物的组合进行研究。PROSPERO 注册号：CRD42022379341。