Guojun Wang, Su Jing, Youlong Zhu, L. Gong
We evaluated the diagnostic accuracy of serum homocysteine (HCY) for predicting intestinal necrosis in patients with bowel obstruction and compared its performance with conventional inflammatory biomarkers. This prospective observational study enrolled consecutive patients presenting with acute bowel obstruction between Feb 2024 and Feb 2026. Serum biomarkers including HCY, procalcitonin (PCT), C-reactive protein (CRP), endotoxin, and interleukins were measured within 24 h of admission in all 205 patients. The primary outcome was intestinal necrosis confirmed by surgical pathology or contrast-enhanced computed tomography (CT). Receiver operating characteristic (ROC) curves and multivariable logistic regression were performed. Of 205 patients enrolled, 132 (64.4%) developed intestinal necrosis. Serum HCY was significantly elevated in the necrosis group (median 24.16 vs. 11.50 µmol/L; P < 0.001). Multivariable analysis identified HCY as the strongest independent predictor (OR 1.515; 95%CI 1.262–1.817; P < 0.001), followed by endotoxin (OR 1.070; 95%CI 1.034–1.107; P < 0.001), interleukin (IL)-1β (OR 1.068; 95%CI 1.010–1.129; P = 0.021), age (OR 1.069; 95%CI 1.008–1.134; P = 0.027), and CRP (OR 1.019; 95%CI 1.001–1.037; P = 0.040). PCT was entered but was not independently significant after adjustment ( P = 0.940). HCY achieved AUC = 0.946 (95%CI 0.913–0.974), significantly higher than all comparators after Bonferroni correction (all P < 0.0083). At an optimal cutoff of 15.56 µmol/L, HCY demonstrated sensitivity of 93.9% and specificity of 82.2%. Patients with HCY < 10 µmol/L had 0% necrosis; those with HCY ≥ 25 µmol/L had 100% necrosis. Serum HCY is a highly accurate biomarker strongly associated with intestinal necrosis in bowel obstruction, outperforming all conventional inflammatory markers after correction for multiple comparisons. These findings warrant multicenter external validation before clinical implementation.