Blauw Juliëtte T M, Metz Flores M, Nuzzo Alexandre, van Etten-Jamaludin Faridi S, Brusse-Keiser Marjolein, Boermeester Marja A, Peppelenbosch Maikel, Geelkerken Robert H
Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Surgery, Amsterdam University Medical Centre, Amsterdam, The Netherlands.
Department of Vascular Surgery, Medisch Spectrum Twente, Enschede, The Netherlands; Dutch Expert Centre for Gastrointestinal Ischaemia, Enschede, The Netherlands; Multi-Modality Medical Imaging group, TechMed Centre, University of Twente, Enschede, The Netherlands.
Eur J Vasc Endovasc Surg. 2024 Apr;67(4):554-569. doi: 10.1016/j.ejvs.2023.08.059. Epub 2023 Aug 26.
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.
The Pubmed, Embase, and the Cochrane Library electronic databases were searched.
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).
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.
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.
迫切需要准确的生物标志物来支持急性肠系膜缺血（AMI）的及时诊断，从而改善临床结局。通过本系统评价，旨在证实生物标志物对动脉闭塞性AMI的潜在诊断价值。
检索了Pubmed、Embase和Cochrane图书馆电子数据库。
对文献进行系统评价，以确定生物标志物对动脉闭塞性AMI的潜在诊断价值。在Pubmed、Embase和Cochrane图书馆电子数据库中，识别出所有在1950年至2023年2月17日期间纳入≥10例描述大血管闭塞性AMI生物标志物患者的研究。对任何特定的研究设计均无限制，但排除了信函和社论。使用QUADAS-2工具进行质量的批判性评价。研究方案已在国际系统评价注册库（CRD420212）上注册。
4334项研究中有50项符合纳入本综述的条件。90%的研究质量较低。共识别出60种生物标志物，其中24种在两项或更多研究中出现，15种在五项或更多研究中出现。报告的单位、正常范围和临界值存在差异。由于研究的异质性，无法进行荟萃分析。《欧洲血管与血管内外科杂志》、欧洲创伤与急诊外科学会2016年以及世界急诊外科学会2017年指南目前推荐的生物标志物在用于AMI诊断时也有低质量的异质性数据。
本系统评价表明，关于动脉闭塞性AMI生物标志物的现有证据具有高度异质性和低质量。对于疑似动脉闭塞性AMI的患者，无法就单一生物标志物或生物标志物组合得出临床结论。建议在仅基于生物标志物拒绝或确定AMI时保持谨慎。
