Purpose of review Gut barrier
failure is associated with bacterial translocation, systemic inflammation, and is presumed to be associated with the development of multiple organ dysfunction syndrome. As the gut barrier
function is carried out by a monolayer of enterocytes, a minimum requirement is the integrity of the enterocytes, and controlled paracellular permeability between adjacent enterocytes. Many factors can cause critically ill
patients to lose gut barrier
function by a mechanism of enterocyte
damage; for example, small bowel ischemia or hypoxia, sepsis, systemic inflammatory response syndrome, or absence of enteral feeding.
biomarkers may help the intensivist to identify enterocyte
damage and dysfunction, namely plasma citrulline
, a biomarker of functional enterocyte
mass, and plasma or urinary intestinal fatty acid-binding protein
, a marker of enterocyte
damage. This review focuses on results obtained with these biomarkers in the context of critical care, in particular: prevalence of enterocyte
biomarker abnormalities; mechanisms associated with enterocyte
damage and dysfunction; link with systemic inflammation, bacterial translocation, and clinical intestinal dysfunction; prognostic value of enterocyte
biomarkers. Lastly, we also review the limits of these biomarkers.
biomarkers may help the intensivist to identify patients presenting with intestinal damage, and who are at risk of bacterial translocation and systemic inflammatory response syndrome, as well as those with decreased enterocyte
function, at risk of malabsorption. Enterocyte
biomarkers should be interpreted with caution in the critically ill
and should be interpreted within the overall clinical context of the patient.