Plasma concentrations of glutathione S-transferase isoenzyme are raised in patients with intestinal ischaemia

Background: The mortality rate associated with acute mesenteric ischaemia (AMI) remains high. Diagnosis is frequently confounded by the non‐specific history and physical signs, in conjunction with the absence of a reliable biological assay. Glutathione S‐transferase (GST) is an enzyme with a crucial role in cellular homoeostasis, the α isoenzyme of which is highly specific to small bowel and liver. This study assessed αGST as a marker for AMI. Methods: Twenty‐six patients with acute abdominal pain were enrolled. Each patient manifested a diagnostic dilemma, with a potential diagnosis of AMI. Plasma was reserved for αGST assay during routine blood testing and stored at – 20°C for analysis. A final diagnosis was made by autopsy, laparotomy, a definitive other investigation or a return to full health. Results: Twelve patients had AMI. Plasma αGST was significantly increased in patients with AMI (P < 0·0001). Although pH differed and other biochemical changes occurred, only αGST accurately predicted AMI. Conclusion: A threshold of 4 ng/ml for αGST was 100 per cent sensitive and 86 per cent specific for AMI. If these observations can be confirmed, evaluation of αGST may reliably predict the presence or absence of AMI. © 1999 British Journal of Surgery Society Ltd