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Serum intestinal fatty-acid binding protein: predictor of bowel necrosis in pediatric intussusception
Adesoji Ademuyiwa1, Felix Alakaloko2, Olumide Elebute2
1Paediatric Surgery Unit, Department of Surgery, College of Medicine, University of Lagos; Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria.
Insights
Serum Intestinal Fatty-Acid Binding Protein (I-FABP) can help identify bowel necrosis in pediatric intussusception. Higher I-FABP levels indicate a greater likelihood of necrotic bowel requiring surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Biomarker Research
Background:
- Intussusception is a common surgical emergency in children.
- Early diagnosis of bowel necrosis is crucial for optimal outcomes.
- Serum Intestinal Fatty-Acid Binding Protein (I-FABP) is a potential biomarker for bowel necrosis.
Purpose of the Study:
- To evaluate the diagnostic accuracy of serum I-FABP in pediatric intussusception.
- To determine the sensitivity and specificity of I-FABP for detecting bowel necrosis.
- To correlate I-FABP levels with the extent of necrotic small bowel.
Main Methods:
- Prospective study of 50 children with intussusception and 25 controls.
- Serum I-FABP levels measured and compared between groups (necrotic bowel, non-necrotic bowel, controls).
- Receiver Operating Characteristic (ROC) curve analysis used to determine cut-off values and diagnostic performance (sensitivity, specificity, PPV, NPV).
Main Results:
- Children with necrotic intussusception had significantly higher median serum I-FABP levels (2056.0 ng/ml) compared to those without necrosis (943.0 ng/ml) and controls (478.0 ng/ml).
- A cut-off value of 1538 ng/ml yielded a sensitivity of 64%, specificity of 88%, PPV of 84%, and NPV of 71%.
- I-FABP levels > 1538 ng/ml were associated with a 13-fold increased likelihood of necrotic bowel.
Conclusions:
- Serum I-FABP demonstrates moderate sensitivity in differentiating bowel necrosis in pediatric intussusception.
- Elevated I-FABP levels predict an increased likelihood of bowel resectability.
- I-FABP serves as a valuable diagnostic aid in managing intussusception.
Background/Purpose:
Serum Intestinal Fatty-Acid Binding Protein (I-FABP) is a useful marker of bowel necrosis in pediatric intussusception. The aim of this study is to determine the sensitivity of this marker and correlate it with length of necrosed small bowel.
Methods:
A single-centre prospective study of 50 children presenting to Lagos University Teaching Hospital, Nigeria, in whom a diagnosis of intussusception was made over 1 year was completed. Additionally, 25 age- and sex-matched controls (day case surgery) were recruited. They were grouped into three: 25 children with necrotic bowel, 25 without bowel necrosis, and 25 controls. The serum IFABP levels were compared between the cohorts with confirmed bowel necrosis at surgery and those with no necrosis, as well as controls. The cut-off values for the diagnosis of bowel necrosis were calculated using a receiver operating characteristic curve (ROC). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated.
Results:
Twenty-five children were diagnosed with necrotic intussusception whose serum IFABP immunoassay has significantly higher median compared with those without necrosis and controls (2056.0ng/ml vs. 943.0ng/ml and 478.0ng/ml P=0.0002). Using a cut-off value of 1538ng/ml, the sensitivity, specificity, PPV, and NPV were 64%, 88%, 84%, and 71%, respectively. I-FABP titer greater than 1538ng/ml was found to have higher likelihood of necrotic bowel (p=0.002; odds ratio 13.04; 95% confidence interval; 0.618-0.891).
Conclusion:
Serum I-FABP is moderately sensitive for discriminating between bowel necrosis, and it predicts increased likelihood of bowel resectability in intussusception.
Level Of Evidence:
Level II - Development of diagnostic criteria in a consecutive series of patients and a universally applied "gold standard".
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