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

Fragkos, KC; Forbes, A; (2017) Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis. United European Gastroenterology Journal 10.1177/2050640617737632. (In press). Green open access

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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.

Type: Article
Title: Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis
Open access status: An open access version is available from UCL Discovery
DOI: 10.1177/2050640617737632
Publisher version: http://dx.doi.org/10.1177/2050640617737632
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Citrulline, meta-analysis, short bowel syndrome, enteropathy, systematic review
URI: https://discovery.ucl.ac.uk/id/eprint/10026175
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