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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

doi: 10.1097/CCM.0b013e31828c26b5
Clinical Investigations

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.

1Intensive Care Unit, University Hospital, Besançon, France.

2Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besançon, France.

3Clinical Chemistry Unit, University Hospital, Besançon, France.

4Physiology Department, University Hospital, Besançon, France.

5Clinical Methodology Center, University Hospital, Besançon, France.

6Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia.

* See also p. 2238.

Supported, in part, by the Intensive Care Unit and Clinical Chemistry Unit of Besançon University Hospital.

Dr. Capellier has consulted for Gambro, received grant support from General Electric, payment for development of educational presentations from LFB, and travel reimbursements from Don Du Souffle Franche Comte. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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