Konstantinos C Fragkos1, Alastair Forbes2. 1. 1University College London Hospitals, GI Services, London, UK. 2. University of East Anglia, Norwich and Norfolk Medical School, Norwich, UK.
Abstract
BACKGROUND: Citrulline has been described as a marker of intestinal function or absorption but evidence varies according to clinical settings. OBJECTIVE: The objective of this article is to examine the evidence of plasma citrulline as a marker of intestinal function and absorption in various clinical settings. METHODS: Studies were examined for p values, means and standard deviations, correlation coefficients or other metrics depicting the association of citrulline with intestinal function. A random effects model was used to produce a pooled estimate. A hierarchical summary receiver operating curve model was fitted for diagnostic accuracy measures. RESULTS: Citrulline levels are correlated strongly with small bowel length in short bowel syndrome patients (r = 0.67). Citrulline is strongly negatively correlated (r = -0.56) with intestinal disease severity with regards to enteropathies (coeliac disease, tropical enteropathy, Crohn's disease, mucositis, acute rejection in intestinal transplantation). Citrulline cut-off levels have an overall sensitivity and specificity of 80% and 84% respectively. Citrulline levels in untreated coeliac patients compared to controls were reduced by 10 µmol/l. Citrulline levels increase with gluten-free diet and with improvement of enteropathy. Citrulline is decreased in critical illness and sepsis. CONCLUSION: These findings allow us to advocate quite reasonably that citrulline is a marker of acute and chronic intestinal insufficiency.
BACKGROUND: Citrulline has been described as a marker of intestinal function or absorption but evidence varies according to clinical settings. OBJECTIVE: The objective of this article is to examine the evidence of plasma citrulline as a marker of intestinal function and absorption in various clinical settings. METHODS: Studies were examined for p values, means and standard deviations, correlation coefficients or other metrics depicting the association of citrulline with intestinal function. A random effects model was used to produce a pooled estimate. A hierarchical summary receiver operating curve model was fitted for diagnostic accuracy measures. RESULTS: Citrulline levels are correlated strongly with small bowel length in short bowel syndrome patients (r = 0.67). Citrulline is strongly negatively correlated (r = -0.56) with intestinal disease severity with regards to enteropathies (coeliac disease, tropical enteropathy, Crohn's disease, mucositis, acute rejection in intestinal transplantation). Citrulline cut-off levels have an overall sensitivity and specificity of 80% and 84% respectively. Citrulline levels in untreated coeliac patients compared to controls were reduced by 10 µmol/l. Citrulline levels increase with gluten-free diet and with improvement of enteropathy. Citrulline is decreased in critical illness and sepsis. CONCLUSION: These findings allow us to advocate quite reasonably that citrulline is a marker of acute and chronic intestinal insufficiency.
Entities:
Keywords:
Citrulline; enteropathy; meta-analysis; short bowel syndrome; systematic review
Authors: Ludy C H W Lutgens; Nicole M A Blijlevens; Nicolaas E P Deutz; J Peter Donnelly; Philippe Lambin; Ben E de Pauw Journal: Cancer Date: 2005-01-01 Impact factor: 6.860
Authors: A I David; J J Gaynor; P P Zis; L Conanan; L Goldsmith; V Esquenazi; G Selvaggi; D Weppler; S Nishida; J Moon; J R Madariaga; P Ruiz; T Kato; D M Levi; G Kleiner; P Tryphonopoulos; A G Tzakis Journal: Transplant Proc Date: 2006 Jul-Aug Impact factor: 1.066
Authors: Andre I David; Gennaro Selvaggi; Phillip Ruiz; Jeffrey J Gaynor; Panagiotis Tryphonopoulos; Gary I Kleiner; Jang I Moon; Seigo Nishida; Peter A Pappas; Lobella Conanan; Debbie Weppler; Violet Esquenazi; David M Levi; Tomoaki Kato; Andreas G Tzakis Journal: Transplantation Date: 2007-11-15 Impact factor: 4.939
Authors: Gabriel E Gondolesi; Stuart S Kaufman; Claude Sansaricq; Margret S Magid; Kimiyo Raymond; Liesl P Iledan; Ye Tao; Sander S Florman; Neal S LeLeiko; Thomas M Fishbein Journal: Am J Transplant Date: 2004-03 Impact factor: 8.086
Authors: Jibran A Wali; Yen Chin Koay; Jason Chami; Courtney Wood; Leo Corcilius; Richard J Payne; Roman N Rodionov; Andreas L Birkenfeld; Dorit Samocha-Bonet; Stephen J Simpson; John F O'Sullivan Journal: Am J Physiol Endocrinol Metab Date: 2020-07-14 Impact factor: 4.310
Authors: Leila B Giron; Harsh Dweep; Xiangfan Yin; Han Wang; Mohammad Damra; Aaron R Goldman; Nicole Gorman; Clovis S Palmer; Hsin-Yao Tang; Maliha W Shaikh; Christopher B Forsyth; Robert A Balk; Netanel F Zilberstein; Qin Liu; Andrew Kossenkov; Ali Keshavarzian; Alan Landay; Mohamed Abdel-Mohsen Journal: Front Immunol Date: 2021-06-09 Impact factor: 7.561