Glucagon-like Peptide-1 as a Promising Marker of Postoperative Intestinal Ischemia After Abdominal Aortic Surgery

Acute intestinal ischemia is a severe postoperative complication of abdominal aortic surgery, and delayed diagnosis markedly limits therapeutic options. At present, no reliable biochemical marker for early detection is available. This study assesses whether perioperative changes in glucagon-like peptide-1 (GLP-1) may serve as an early biomarker of postoperative intestinal ischemia.

This prospective single-center cohort study enrolled 80 patients undergoing elective abdominal aortic surgery. Total serum GLP-1 concentrations were measured at 8 perioperative time points spanning the preoperative, intraoperative, and postoperative periods. Intestinal ischemia was diagnosed using contrast-enhanced magnetic resonance imaging or surgical confirmation.

The perioperative time course of GLP-1 was similar across all patients, with peak concentrations consistently observed 24 hr after complete declamping during vascular reconstruction. Six patients developed intestinal ischemia; these individuals exhibited significantly higher GLP-1 levels at all postoperative time points than patients without ischemia (P < 0.02). GLP-1 demonstrated the highest predictive ability at 24 hr after complete declamping (area under the receiver operating characteristic curve [AUC] 0.993); similarly, measurements obtained at 6 hr after complete declamping exhibited excellent predictive performance (AUC 0.919).

Perioperative elevation of GLP-1 demonstrates high specificity for intestinal ischemia, independent of diabetes mellitus or age. Serum GLP-1 concentrations show promise as reliable predictive biomarkers for postoperative intestinal ischemia, with the best diagnostic accuracy observed at 6 and 24 hr after complete declamping during vascular reconstruction.