Exploring I-FABP, endothelin-1 and L-lactate as biomarkers of acute intestinal necrosis: a case-control study

Abstract

Objective

Acute intestinal necrosis (AIN) is a disease with devastating high mortality. AIN due to obstructed arterial blood flow has a blurred clinical presentation. Timely diagnosis is paramount, and a blood-based biomarker is warranted to increase patient survival. We aimed to assess intestinal fatty acid binding protein (I-FABP) and endothelin-1 as diagnostic biomarkers for AIN. To our knowledge, this is the first study exploring endothelin-1 in AIN patients from a general surgical population.

Design

We conducted a single-centre nested case–control study comparing acutely admitted AIN patients to age- and sex-matched non-AIN patients during 2015–2016. I-FABP and endothelin-1 were analysed using an enzyme-linked immunosorbent assay. L-lactate levels were also measured in all patients. Cut-offs were estimated using receiver operator characteristic curves, and the diagnostic performance was estimated using the area under the receiver operator characteristic curve (AUC).

Results

We identified 43 AIN patients and included 225 matched control patients. Median levels of I-FABP, endothelin-1 and L-lactate were 3550 (IQR: 1746–9235) pg/ml, 3.91 (IQR: 3.33–5.19) pg/ml and 0.92 (IQR: 0.74–1.45) mM in AIN patients and 1731 (IQR: 1124–2848) pg/ml, 2.94 (IQR: 2.32–3.82) pg/ml and 0.85 (IQR: 0.64-1.21) mM in control patients, respectively. The diagnostic performances of endothelin-1 and of I-FABP + endothelin-1 combined were moderate. Endothelin-1 alone revealed an AUC of 0.74 (0.67; 0.82). The sensitivity and specificity of endothelin-1 were 0.81 and 0.64, respectively.

Conclusion

I-FABP and endothelin-1 are promising biomarkers for AIN, with moderate diagnostic performance compared with the commonly used biomarker L-lactate.

Preregistration

ClinicalTrials.gov: NCT05665946.

Keywords:

• Mesenteric ischemia
• diagnosis
• fatty acid-binding protein
• endothelin-1
• lactate

Acknowledgement

The authors want to thank research technician Lone Larsen for her excellent analytical work with I-FABP and endothelin-1, research technician Kirsten Kolind for her skilful work with L-lactate and June Lundtoft Køjborg for her careful handling of the pre-analytical blood samples.

Ethical approval

This study was approved by The North Denmark Region Committee on Health Research Ethics (N-20170089).

Disclosure statement

All authors declare that they have no conflicts of interest.

Data availability statement

The research data is not available due to the nature of this research. Participants might be identified from the data due to the nature and number of patients suffering from AIN and they did not agree for their data to be shared publicly, so supporting data is not available. Analytical methods can be requisitioned from the authors on reasonable request.

Additional information

Funding

This study was funded by the Axel Muusfeldts foundation under Grant number 2020-0008.