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

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.