Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31828c26b5
Clinical Investigations

Enterocyte Damage in Critically Ill Patients Is Associated With Shock Condition and 28-Day Mortality*

Piton, Gaël MD1,2; Belon, François MD1; Cypriani, Benoit MD3; Regnard, Jacques MD, PhD2,4; Puyraveau, Marc MS5; Manzon, Cyril MD1; Navellou, Jean-Christophe MD1; Capellier, Gilles MD, PhD1,2,5

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Objectives: Small bowel dysfunction in critically ill patients is frequent, underdiagnosed, and associated with poor prognosis. Intestinal fatty acid-binding protein is a marker of enterocyte damage, and plasma citrulline concentration is a marker of functional enterocyte mass. Primary objective was to identify factors associated with intestinal fatty acid-binding protein in critically ill patients. Secondary objectives were to study factors associated with plasma citrulline concentration and its correlation with intestinal fatty acid-binding protein.

Design: Prospective observational study.

Setting: ICU in a University Hospital

Patients: Critically ill patients 18 years old or older with an expected length of ICU stay 48 hours or more, without pregnancy, chronic small bowel disease, or chronic renal failure.

Interventions: None.

Measurements and Main Results: Plasma intestinal fatty acid-binding protein and citrulline concentrations, and variables relating to prognosis and treatment, were measured at admission to the ICU. One hundred and three patients were included. Intestinal fatty acid-binding protein elevation at admission to the ICU was associated with catecholamine support, higher lactate concentration, higher Sequential Organ Failure Assessment score, and higher international normalized ratio (all p ≤ 0.001). Plasma citrulline concentration less than or equal to 10 μmol/L at admission to the ICU was associated with higher intra-abdominal pressure, higher plasma C reactive protein concentration, and more frequent antibiotic use (all p ≤ 0.005). There was no correlation between plasma levels of intestinal fatty acid-binding protein and citrulline. At ICU admission, Sequential Organ Failure Assessment score ≥12, plasma citrulline ≤ 12.2 μmol/L, and plasma intestinal fatty acid-binding protein concentration ≥355 pg/mL were all independently associated with 28-day mortality (odds ratio, 4.39 [1.48–13.03]; odds ratio, 5.17 [1.59–16.86]; and odds ratio, 4.46 [1.35–14.74], respectively).

Conclusions: In critically ill patients, enterocyte damage is frequent, and it is significantly associated with shock and 28-day mortality. The link between intestinal fatty acid-binding protein and plasma citrulline concentrations in critically ill patients needs to be further evaluated.

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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