Biomarkers in Acute Mesenteric Ischemia: A Systematic Review of Diagnostic Performance and Injury-Related Signals

Background/Objectives: We examined nine biomarkers for acute mesenteric ischemia (AMI) detection, necrosis and postoperative prediction. Methods: PubMed/MEDLINE, the Cochrane Library and indexed citation links were searched on 10 October 2026 without a lower publication-year limit. PubMed and citation searches used an October 2026 publication cutoff. English- and Russian-language clinical reports with at least 10 participants were eligible. Narrative synthesis used QUADAS-2 and diagnostic GRADE. Results: Twenty-nine primary reports were included, with reported cohorts of 18–1479 participants. Cohort overlap and varying tested denominators precluded an unduplicated participant total. Among 28 diagnostic reports, 22 had high index-test risk and 25 had high flow/timing risk. Certainty was very low for eight markers. I-FABP, α-GST and citrulline findings depended on population, assay and timing. D-dimer, lactate, procalcitonin and ischemia-modified albumin lacked intestinal specificity. Urinary I-FABP estimates were imprecise. SM22 supplied association data without diagnostic-performance estimates. Conclusions: No evaluated marker supports reliable stand-alone exclusion of AMI or determination of bowel viability. Complementary panels require prospective validation. The injury diagrams are unvalidated research models.