Emerging Biomarkers for Early Diagnosis of Acute Mesenteric Ischemia: A Systematic Review

Abstract

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-1 α , 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.