The Diagnostic Value of Biomarkers in Acute Mesenteric Ischaemia Is Insufficiently Substantiated: A Systematic Review
Open accessAbstract
OBJECTIVE: There is an urgent need for accurate biomarkers to support timely diagnosis of acute mesenteric ischaemia (AMI) and thereby improve clinical outcomes. With this systematic review, the aim was to substantiate the potential diagnostic value of biomarkers for arterial occlusive AMI. DATA SOURCES: The Pubmed, Embase, and the Cochrane Library electronic databases were searched. REVIEW METHODS: A systematic review of the literature has been conducted to define the potential diagnostic value of biomarkers for arterial occlusive AMI. All studies including ≥ 10 patients describing biomarkers for macrovascular occlusive AMI between 1950 and 17 February 2023 were identified within the Pubmed, Embase, and the Cochrane Library electronic databases. There were no restrictions to any particular study design, but letters and editorials were excluded. The QUADAS-2 tool was used for the critical appraisal of quality. The study protocol was registered on Prospero (CRD42021254970). RESULTS: Fifty of 4334 studies were eligible for inclusion in this review. Ninety per cent of studies were of low quality. A total of 60 biomarkers were identified, with 24 in two or more studies and 15 in five or more studies. There was variation in reported units, normal range, and cut off values. Meta-analysis was not possible due to study heterogeneity. Biomarkers currently recommended by the European Journal of Vascular and Endovascular Surgery, European Society for Trauma and Emergency Surgery 2016, and World Society of Emergency Surgery 2017 guidelines also had heterogeneous low quality data for use in the diagnosis of AMI. CONCLUSION: This systematic review demonstrates high heterogeneity and low quality of the available evidence on biomarkers for arterial occlusive AMI. No clinical conclusions can be drawn on a biomarker or combination of biomarkers for patients suspected of arterial occlusive AMI. Restraint is advised when rejecting or determining AMI solely based on biomarkers.
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The negative predictive value of D dimer in other studies ranged between 87% and 96%.
“However, the NPV of D dimer in other studies ranged between 87% and 96%, indicating that the test is not perfect for ruling out AMI, also because of the variety of cutoff values and assays used. 127”
Clinical management cannot be based on the use of a single biomarker to establish or rule out AMI.
“It was concluded that clinical management cannot be based on the use of a single biomarker to establish or rule out AMI. 127”
In the most recent systematic review, 60 different biomarkers for detecting arterial occlusive AMI in humans were identified.
“In the most recent systematic review, a total of 60 different biomarkers for detecting arterial occlusive AMI in humans were identified. 127”
In that systematic review, 15 biomarkers were evaluated in five or more studies, 21 in two or more studies, and 24 in a single study.
“Fifteen biomarkers were evaluated in five or more studies, 21 biomarkers in two or more studies, and 24 in a single study.”
The authors of the most recent systematic review refrained from meta-analysis because of wide heterogeneity between studies due to differences in study populations, normal and cutoff values, verification bias, small sample sizes, and high risk of bias.
“Given the wide heterogeneity between the studies due to the differences in study populations, normal and cutoff values, verification bias, small sample sizes, and high risk of bias, the authors refrained from meta-analysis.”
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Koelemay, M. J., Geelkerken, R. H., Kärkkäinen, J., Leone, N., Antoniou, G. A., de Bruin, J. L., Gombert, A., Gottsätter, A., Iborra, E., Ronchey, S., et al. (2025) · European Journal of Vascular and Endovascular Surgery · doi:10.1016/j.ejvs.2025.06.010 · Cited by 123 · see citing works
Self-citation
- Authors
- Blauw, J. T. M., Metz, F. M., Nuzzo, A., van Etten - Jamaludin, F. S., Brusse-Keiser, M., Boermeester, M. A., Peppelenbosch, M., & Geelkerken, R. H.
- Affiliations
- Medisch Spectrum Twente (NL)
- Université Paris Cité (FR)
- Amsterdam UMC Location University of Amsterdam (NL)
- Erasmus MC (NL)
- Corresponding author
- Geelkerken, Robert H.
- ORCID
- Venue
- European Journal of Vascular and Endovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2024-04
- Volume
- 67
- Issue
- 4
- Pages
- 554-569
- ISSN
- 1078-5884 (ISSN-L)
- OpenAlex
- W4386190030
- Cited by
- 20
- References
- 15
- Citations by year
- 2026: 8 · 2025: 10 · 2024: 2
- FWCI
- 1.30
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Journal of Vascular and Endovascular Surgery (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, cc-by-nc-nd)
- University of Twente Research Information (submittedVersion, cc-by-nc-nd)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Emergency Medicine › Appendicitis Diagnosis and Management
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- acute mesenteric ischemia, biomarkers, diagnostic accuracy, biomarker heterogeneity, clinical guidelines
- MeSH terms
- Acute Disease, Arterial Occlusive Diseases, Humans, Mesenteric Vascular Occlusion, Predictive Value of Tests, Biomarkers, Mesenteric Ischemia
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