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Circulating Intestinal Fatty Acid-Binding Protein as an Early Marker of Intestinal Necrosis After Aortic Surgery: A Prospective Observational Cohort Study

Vermeulen Windsant, Iris C. MD*,†; Hellenthal, Femke A. MD*,‡; Derikx, Joep P. M. MD, PhD*,§; Prins, Martin H. MD, PhD; Buurman, Wim A. PhD*,‖; Jacobs, Michael J. MD, PhD*,‡,‖; Schurink, Geert Willem H. MD, PhD*,‡,‖

doi: 10.1097/SLA.0b013e31824b1e16
Original Articles

Objective: This study evaluated the usefulness of plasma intestinal fatty-acid binding protein (IFABP) levels in the early identification of intestinal necrosis (IN) in patients undergoing different types of aortic surgery.

Background: Intestinal compromise greatly contributes to postoperative adverse outcome. IN is the most detrimental form of intestinal compromise and is notoriously difficult to diagnose. IFABP is a small protein exclusively expressed by mature enterocytes and a promising marker of intestinal damage.

Methods: Plasma IFABP concentrations were measured in blood samples taken perioperatively from 55 patients undergoing open thoracic or thoracoabdominal aneurysm repair [OR-TAA(A)], 25 patients undergoing conventional open abdominal aneurysm repair (OR-abdominal aortic aneurysm [AAA]), and 16 patients undergoing endovascular aneurysm repair (EVAR). Data were compared with perioperative changes in arterial pH and serum lactate levels.

Results: IFABP levels increased in all patients undergoing OR-TAA(A) and OR-AAA reaching peak levels shortly after surgery; 281 ± 33 to 2,298 ± 490 pg/mL (P < 0.001) and 187 ± 31 to 641 ± 176 pg/mL (P < 0.05) respectively. IFABP levels were significantly higher in patients undergoing OR-TAA(A) (P < 0.001). IFABP levels in EVAR patients remained at baseline concentrations throughout the study. Four patients [2 OR-AAA, 2 OR-TAA(A)] developed fatal postoperative intestinal ischemia on day 2 or 3. High levels of plasma IFABP at the end of surgery had 100% sensitivity and 98.1% specificity for the identification of patients developing IN. In OR-AAA patients, arterial pH and lactate levels were of additional discriminating value. Complete discrimination between patients with and without IN using plasma IFABP could be made on the first postoperative day.

Conclusions: Analysis of plasma IFABP levels is of additional value to other current plasma markers in the diagnosis of IN, and it enables early identification of patients with IN after aortic surgery days before clinical diagnosis.

Supplemental Digital Content is available in the text.Intestinal necrosis after aortic surgery is a major cause of postoperative death and is notoriously difficult to diagnose. This study provides evidence that early assessment of plasma levels of intestinal fatty acid binding protein could significantly contribute to timely identification of patients with postoperative intestinal necrosis.

*Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

Nutrition and Toxicology Research Institute Maastricht (NUTRIM), Maastricht University Medical Center, Maastricht, The Netherlands

Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands

§Department of Surgery, Orbis Medical Center, Sittard, The Netherlands

Department of Epidemiology, Maastricht University Medical Center, Maastricht, The Netherlands

European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital Aachen, Aachen, Germany.

Reprints: Wim A. Buurman, PhD, Department of Surgery, Maastricht University Medical Centre, PO Box 616, Maastricht, The Netherlands. E-mail: w.buurman@maastrichtuniversity.nl.

Disclosure: Supported by AGIKO-stipendium 920-03-438 from The Netherlands Organisation for Health Research and Development (to J.P.M.D.).

I.C.V.W. and F.A.H. contributed equally to this manuscript.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).

© 2012 Lippincott Williams & Wilkins, Inc.