Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis

Fragkos, Konstantinos C and Forbes, Alastair (2018) Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis. United European Gastroenterology Journal, 6 (2). pp. 181-191. ISSN 2050-6406

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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.

Item Type: Article
Uncontrolled Keywords: citrulline,meta-analysis,short bowel syndrome,enteropathy,systematic review
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
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Depositing User: Pure Connector
Date Deposited: 13 Mar 2018 15:30
Last Modified: 18 Mar 2020 01:07
URI: https://ueaeprints.uea.ac.uk/id/eprint/66483
DOI: 10.1177/2050640617737632

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