Background: Acute mesenteric ischemia (AMI) is a life-threatening condition caused by occlusive or non-occlusive compromise of intestinal blood flow. Early diagnosis is challenging because clinical signs and routine laboratory tests lack sensitivity. Emerging biomarkers (I-FABP, citrulline, D-lactate, GLP-1/2, SM22, adropin, HIF-1α, volatile organic compounds) show promise for earlier detection and disease staging. Methods: A systematic literature search was conducted across PubMed, Embase, and the Cochrane Library from inception through March 2025. Inclusion criteria were: 1) Original studies or meta-analyses evaluating diagnostic accuracy of one or more biomarkers for AMI in human subjects; 2) Reporting of diagnostic performance metrics (sensitivity, specificity, AUC, or 2 × 2 contingency data); 3) English-language publications. Exclusion criteria were animal-only studies, case reports, editorials, and studies evaluating chronic mesenteric ischemia exclusively. Results: I-FABP demonstrated the strongest and most consistent diagnostic performance. Conclusion: No single biomarker currently replaces CTA or clinical judgment. I-FABP is the most validated plasma marker for vascular AMI and intestinal necrosis. Combinatorial panels including I-FABP, SM22, villin-1, and novel markers (GLP-1/2, VOCs) show promise to improve early diagnosis and risk stratification. Prospective multicenter validation and integration with imaging pathways are required before routine clinical implementation.
References
[1]
Bala, M., Catena, F., Kashuk, J., De Simone, B., Gomes, C.A., Weber, D., et al. (2022) Acute Mesenteric Ischemia: Updated Guidelines of the World Society of Emergency Surgery. World Journal of Emergency Surgery, 17, Article No. 54. https://doi.org/10.1186/s13017-022-00443-x
[2]
Peoc’h, K., Nuzzo, A., Guedj, K., Paugam, C. and Corcos, O. (2018) Diagnosis Biomarkers in Acute Intestinal Ischemic Injury: So Close, Yet So Far. Clinical Chemistry and Laboratory Medicine, 56, 373-385. https://doi.org/10.1515/cclm-2017-0291
[3]
Nuzzo, A., Guedj, K., Curac, S., Hercend, C., Bendavid, C., Gault, N., et al. (2021) Accuracy of Citrulline, I-FABP and D-Lactate in the Diagnosis of Acute Mesenteric Ischemia. Scientific Reports, 11, Article No. 18929. https://doi.org/10.1038/s41598-021-98012-w
[4]
El Hamwi, A., Hamard, F., Hinault-Boyer, C., Raffort, J., Lareyre, F., Grober, J., et al. (2025) New Biomarkers of Acute Intestinal Ischemia: A Prospective Study Validating the Interest of GLP-1 and GLP-2. JournaloftheAmericanCollegeofSurgeons, 241, 610-618. https://doi.org/10.1097/xcs.0000000000001453
[5]
Schellekens, D.H.S.M., Reisinger, K.W., Lenaerts, K., Hadfoune, M., Olde Damink, S.W., Buurman, W.A., et al. (2018) SM22 a Plasma Biomarker for Human Transmural Intestinal Ischemia. AnnalsofSurgery, 268, 120-126. https://doi.org/10.1097/sla.0000000000002278
[6]
Duivenvoorden, A.A.M., Clarysse, M., Ceulemans, L.J., Geelkerken, R.H., Derikx, J.P.M., de Vries, J.P.M., et al. (2023) Diagnostic Potential of Plasma Biomarkers and Exhaled Volatile Organic Compounds in Predicting the Different Stages of Acute Mesenteric Ischaemia: Protocol for a Multicentre Prospective Observational Study (TACTIC Study). BMJOpen, 13, e072875. https://doi.org/10.1136/bmjopen-2023-072875
[7]
Kurt, E., Tekin, E., Kurt, N. and Bayramoglu, A. (2022) The Role of Adropin, HIF-1α and Apelin Biomarkers in the Diagnosis of Acute Mesentaric Ischemia. The American Journal of Emergency Medicine, 51, 223-227. https://doi.org/10.1016/j.ajem.2021.10.058
[8]
Whiting, P.F., Tomlinson, E., Rutjes, A.W.S., Davenport, C.F., Yang, B., Westwood, M.E., et al. (2026) QUADAS-3: A Revised Tool for the Quality Assessment of Diagnostic Test Accuracy Studies. Annals of Internal Medicine, 179, 548-555. https://doi.org/10.7326/annals-25-02104
[9]
McInnes, M.D.F., Moher, D., Thombs, B.D., McGrath, T.A., Bossuyt, P.M., Clifford, T., et al. (2018) Preferred Reporting Items for a Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies: The PRIS-MA-DTA Statement. Journal of the American Medical Association, 319, 388-396. https://doi.org/10.1001/jama.2017.19163
[10]
Kulu, R., Akyildiz, H., Akcan, A., Oztürk, A. and Sozuer, E. (2016) Plasma Citrulline Measurement in the Diagnosis of Acute Mesenteric Ischaemia. ANZJournalofSurgery, 87, E57-E60. https://doi.org/10.1111/ans.13524
[11]
Costello, L., Duggan, W.P., Flanagan, M., Toale, C. and Kavanagh, D.O. (2025) Current Approaches to Diagnosis and Management of Acute Mesenteric Ischaemia—A Scoping Review. Digestive Surgery, 42, 229-246.
[12]
Sun, D.L., Cen, Y.Y., Li, S.M., Li, W.M., et al. (2016) Accuracy of the Serum Intestinal Fatty-Acid-Binding Protein for Diagnosis of Acute Intestinal Ischemia: A Meta-Analysis. ScientificReports, 6, Article No. 34371. https://doi.org/10.1038/srep34371
[13]
Matsumoto, S., Sekine, K., Funaoka, H., Yamazaki, M., Shimizu, M., Hayashida, K., et al. (2014) Diagnostic Performance of Plasma Biomarkers in Patients with Acute Intestinal Ischaemia. British Journal of Surgery, 101, 232-238. https://doi.org/10.1002/bjs.9331
[14]
Taghiyev, Z.T., Gunkel, S., Beier, L., Leweling, C., Sadowski, K.M., Arneth, B.M., etal. (2025) Early Detection of Mesenteric Ischemia in Critically Ill Patients Following Cardiac Surgery. Scientific Reports, 15, Article No. 24854. https://doi.org/10.1038/s41598-025-10534-9
[15]
Bourcier, S., Ulmann, G., Jamme, M., Savary, G., Paul, M., Benghanem, S., et al. (2022) A Multicentric Prospective Observational Study of Diagnosis and Prognosis Features in ICU Mesenteric Ischemia: The DIAGOMI Study. Annals of Intensive Care, 12, 113. https://doi.org/10.1186/s13613-022-01092-8
[16]
Kannan, K.B., Colorado, I., Reino, D., Palange, D., Lu, Q., Qin, X., et al. (2011) Hypoxia-Inducible Factor Plays a Gut-Injurious Role in Intestinal Ischemia Reperfusion Injury. American Journal of Physiology-Gastrointestinal and Liver Physiology, 300, G853-G861. https://doi.org/10.1152/ajpgi.00459.2010
[17]
Treskes, N., Persoon, A.M. and van Zanten, A.R.H. (2017) Diagnostic Accuracy of Novel Serological Biomarkers to Detect Acute Mesenteric Ischemia: A Systematic Review and Meta-Analysis. Internal and Emergency Medicine, 12, 821-836. https://doi.org/10.1007/s11739-017-1668-y
