A multicentric prospective observational study of diagnosis and prognosis features in ICU mesenteric ischemia: the DIAGOMI study
Open accessAbstract
BACKGROUND: Non-occlusive mesenteric ischemia (NOMI) is a challenging diagnosis and is associated with extremely high mortality in critically ill patients, particularly due to delayed diagnosis and when complicated by intestinal necrosis. Plasma citrulline and intestinal-fatty acid binding protein (I-FABP) have been proposed as potential biomarkers, but have never been studied prospectively in this setting. We aimed to investigate diagnostic features, the accuracy of plasma citrulline and I-FABP to diagnose NOMI and intestinal necrosis as well as prognosis. METHODS: We conducted a prospective observational study in 3 tertiary ICU centers in consecutive patients with NOMI suspicion defined by at least two inclusion criteria among: new-onset or worsening circulatory failure, gastrointestinal dysfunction, biological signs and CT-scan signs of mesenteric ischemia. Diagnosis features and outcomes were compared according to NOMI, intestinal necrosis or ruled out diagnosis using stringent classification criteria. RESULTS: Diagnosis of NOMI was suspected in 61 patients and confirmed for 33 patients, with intestinal necrosis occurring in 27 patients. Clinical digestive signs, routine laboratory results and CT signs of mesenteric ischemia did not discriminate intestinal necrosis from ischemia without necrosis. Plasma I-FABP was significantly increased in presence of intestinal necrosis (AUC 0.83 [0.70-0.96]). A threshold of 3114 pg/mL showed a sensitivity of 70% [50-86], specificity of 85% [55-98], a negative predictive value of 58% [36-93] and a positive predictive value 90% [67-96] for intestinal necrosis diagnosis. When intestinal necrosis was present, surgical resection was significantly associated with ICU survival (38.5%), whereas no patient survived without necrosis resection (HR = 0.31 [0.12-0.75], p = 0.01). CONCLUSION: In critically ill patients with NOMI, intestinal necrosis was associated with extremely high mortality, and increased survival when necrosis resection was performed. Elevated plasma I-FABP was associated with the diagnosis of intestinal necrosis. Further studies are needed to investigate plasma I-FABP and citrulline performance in less severe forms of NOMI.
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Newer studies assessing intestinal fatty acid-binding protein have been published but do not confirm the initial enthusiasm.
“Newer studies assessing I-FABP have been published, but do not confirm the initial enthusiasm [21, 40, 56, 64, 68].”
From Diagnostic accuracy of biomarkers to detect acute mesenteric ischaemia in adult patients: a systematic review and meta-analysis (2023) · cites this paper as [21]
The Discussion cautions that I-FABP thresholds are not settled and that clinical use is premature, which supports a more guarded view than initial enthusiasm. But the Results report that I-FABP was significantly associated with intestinal necrosis (AUC 0.83), and the Discussion still calls it promising; this study does not simply fail to confirm its potential. Page numbers are unavailable in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredPlasma citrulline and intestinal fatty acid-binding protein have been proposed as potential biomarkers, but have not made it into clinical use owing to suboptimal accuracy.
“Plasma citrulline and intestinal fatty acid-binding protein have been proposed as potential biomarkers, but have not made it into clinical use owing to suboptimal accuracy11,14.”
From Acute mesenteric ischaemia (2023) · cites this paper as [11]
The Introduction (page unavailable) says both biomarkers have been proposed. The Discussion (page unavailable) finds no diagnostic value for citrulline in late-stage NOMI and says I-FABP is promising but too early to integrate into monitoring because its threshold is not settled and its accuracy needs further study. It does not establish that both biomarkers have failed to enter clinical use specifically because of suboptimal accuracy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredNOMI is a result of hypoperfusion (from sepsis, shock, cardiac failure) and use of vasoconstrictors.
“NOMI is a result of hypoperfusion (from sepsis, shock, cardiac failure) and use of vasoconstrictors (Fig. 1c).”
From Acute mesenteric ischaemia (2023) · cites this paper as [11]
The Introduction (page unavailable) says NOMI in critically ill patients is preceded by acute circulatory failure and low mesenteric flow. The Discussion (page unavailable) identifies septic and cardiogenic shock as conditions that may promote NOMI. The Results record norepinephrine use, but do not establish that vasoconstrictors cause NOMI; the claim also states a more definite causal relationship than the Discussion does. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNon-occlusive mesenteric ischaemia typically occurs in patients in the ICU or cardiac care unit.
“Patients with non-occlusive mesenteric ischaemia (NOMI) typically come from the ICU or cardiac care unit11–13.”
From Acute mesenteric ischaemia (2023) · cites this paper as [11]
The Introduction describes NOMI as the main form of mesenteric ischemia in the ICU setting, and the Discussion says it is frequently suspected there. The paper also discusses cardiac conditions associated with NOMI, but does not establish that patients typically come from a cardiac care unit. No page numbers were provided in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredElevated plasma I-FABP is linked to intestinal necrosis in patients with nonocclusive mesenteric ischemia.
“Elevated plasma I-FABP has been linked to intestinal necrosis in patients with nonocclusive mesenteric ischemia [24].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [24]
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References 39 · Cited by 37
- Authors
- Bourcier, S., Ulmann, G., Jamme, M., Savary, G., Paul, M., Benghanem, S., Lavillegrand, J.-R., Schmidt, M., Luyt, C.-E., Maury, E., Combes, A., Pène, F., Neveux, N., & Cariou, A.
- Affiliations
- Centre National de la Recherche Scientifique (FR)
- Université Paris Cité (FR)
- Inserm (FR)
- Assistance Publique – Hôpitaux de Paris (FR)
- Corresponding author
- Bourcier, Simon
- ORCID
- Venue
- Annals of Intensive Care
- Publisher
- Elsevier BV
- Published
- 2022
- Volume
- 12
- Issue
- 1
- Pages
- 113
- ISSN
- 2110-5820 (ISSN-L)
- PMC
- PMC9759607
- OpenAlex
- W4312064757
- Cited by
- 37
- References
- 39
- Citations by year
- 2026: 10 · 2025: 6 · 2024: 15 · 2023: 6
- FWCI
- 6.45
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Annals of Intensive Care (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- HAL (submittedVersion, cc-by)
- HAL (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Nephrology › Acute Kidney Injury Research
- Keywords
- nonocclusive mesenteric ischemia, intestinal necrosis, plasma citrulline, intestinal fatty acid binding protein, biomarkers, diagnosis, prognosis, surgical resection, ICU mortality, critically ill patients, diagnostic accuracy
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