Plasma α-Glutathione S-Transferase in Patients with Chronic Mesenteric Ischemia and Median Arcuate Ligament Syndrome

Figures & data

Figure 1 Flow chart of study individuals.

Table 1 Patient Demographics

	Group A (CMI) n=44	Group B (MALS) n=14	Group C (control) n=16
Age (years)	70 (13) p<0.001*	45 (36) *0.358	45 (21)
Female	26 (59%)	10 (71%)	6 (38%)
BMI (kg/m^2)	20 (3.5) *0.999	21.5 (3.3) *0.935	23.5 (2.3)
Weightloss (kg)	9 (9.3)	7 (6.75)	0
Symptom duration (years)	3 (3)	5 (6.5)	–
CVD	19 (43%)	2 (14%)	0
Hypertension	28 (63%)	4 (29%)	1
Hypercholesterolemia	32 (73%)	3 (21%)	2
Smoking	25 (57%)	7 (50%)	0
COPD	10 (22%)	0	0
Diabetes mellitus	11 (25%)	1 (7%)	0
Renal insufficiency	5 (11%)	0	0
Gastritis	24 (55%)	6 (43%)	0

Notes: *Mann–Whitney U-test comparison with the control group C. Data is present as median (IQR) and n (%).

Abbreviations: CMI, chronic mesenteric ischemia; MALS, median arcuate ligament syndrome; IQR, interquartile range; CVD, cardiovascular disease; COPD, chronic obstructive pulmonary disease.

Figure 2 (A) Median plasma α-glutathione S transferase (α-GST) levels in the patients with chronic mesenteric ischemia due to atherosclerosis (Group A, n=30), and (B) median arcuate ligament syndrome (Group B, n=14), before and after the surgical or endovascular intervention, compared with healthy individuals (Group C, n=16). Boxplot represents the 10^th, 25^th, 50^th, 75^th, and 90^th percentile, with the black horizontal line representing the median. Filled black dots represent outliers. The dotted horizontal line in red represents the upper limits of normal α-GST plasma level. Mann–Whitney U-test is used to test differences between the groups.

Table 2 Analysis of Plasma α-GST >4 ng/mL as the Cut-off for the Diagnosis of Patients with CMI of Atherosclerotic Origin and MALS

CMI
Plasma α-GST Cut-off >4 ng/mL	Positive	Negative	PPV	NPV
Positive	27	2	93%
Negative	3	14		82%
Sensitivity	90%			OA 89%
Specificity		88%
MALS
Positive	12	2	86%
Negative	2	14		88%
Sensitivity	86%			OA 87%
Specificity		88%

Abbreviations: α-GST, α-glutathione S-transferase; CMI, chronic mesenteric ischemia; MALS, median arcuate ligament syndrome; PPV, positive predictive value; NPV, negative predictive value; OA, overall accuracy.

Figure 3 Receiver operating characteristic (ROC) curve and area under the curve (AUC) of median plasma α-GST levels in the patients with chronic mesenteric ischemia (CMI, n=44) due to atherosclerosis and median arcuate ligament syndrome (MALS, n=14). Black (O) and red (O) represent the threshold values for the corresponding sensitivity and specificity. The upper limit of 4 ng/mL was used as a cut-off for α-GST levels. The Grey 45° diagonal line represents random chance (AUC=0.5).

Table 3 Median Plasma Levels of Candidate Mesenteric Ischemia Biomarkers in Patients with CMI Due to Atherosclerosis (Group A), and MALS(Group B), Compared with Healthy Individuals in Group C

	Test Detection Range	Group A		Group B		Group C
		Before	After	Before	After
α-GST (IQR)	0.156 ng/mL - 10 ng/mL	7.8 (3.2) *p <0.001	5.5 (5.3) *p = 0.001	8.4 (5.2) *p = 0.001	3.2 (1.9) *p = 0.064	3.3 (0.5)
I-FABP (IQR)	0.16–10 ng/mL	0.16 (0.1) *p = 0.327	0.16 (0) *p = 0.068	0.16 (0.1) *p = 0.907	0.16 (0.3) *p = 0.504	0.16 (0.1)
Citrulline (IQR)	5.0–100 nmol/mL	2.7 (1.1) p = 0.039	3.2 (1.1) p = 0.503	2.9 (1.1) *p = 0.429	3.1 (0.8) *p = 0.244	3.4 (0.1)
IMA (IQR)	7.8–500 ng/mL	23.4 (0) *p = 1.0	23.4 (0) *p = 1.0	23.4 (0) *p = 0.385	23.4 (0) *p = 1.0	23.4 (0)

Notes: *Mann–Whitney U-test comparison with Group C.

Abbreviations: CMI, chronic mesenteric ischemia; MALS, median arcuate ligament syndrome; α-GST, α- glutathione S transferase; IQR, interquartile range; I-FABP, intestinal fatty acid binding protein; IMA, ischemia-modified albumin.

Table 4 Baseline Plasma Levels of Pancreas Amylase, AST, ALT, CRP and Creatinine in Patients with CMI (Group a, n=44), MALS (Group B, n=14), and Healthy Individuals (Group C, n=16)

Plasma Marker	Reference Range	Group A Median (IQR)	Group B Median (IQR)	Group C Median (IQR)
p-Amylase	10–65 U/L	24 (17)	28 (2)	34 (2)
AST	10–35 U/L	24 (12)	22 (6)	24 (8)
ALT	10–45 U/L	20 (10)	14 (10)	20 (6)
CRP	< 0.1 mg/L	2 (11)	0.9 (2)	1.9 (9)
Creatinine	45–105 µmol/L	70 (26)	69 (19)	78 (18)

Abbreviations: CMI, chronic mesenteric ischemia; MALS, median arcuate ligament syndrome; IQR, interquartile range; AST, aspartate aminotransferase; ALT, alanine aminotransferase; CRP, c-reactive protein.