Serum intestinal fatty-acid binding protein: predictor of bowel necrosis in pediatric 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".