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World Journal of Emergency Surgery

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Open Access 01-12-2019 | Shock | Research article

Is I-FABP not only a marker for the detection abdominal injury but also of hemorrhagic shock in severely injured trauma patients?

Authors: Maika Voth, Thomas Lustenberger, Borna Relja, Ingo Marzi

Published in: World Journal of Emergency Surgery | Issue 1/2019

Abstract

Background

Hemorrhagic shock can lead to intestinal damage with subsequent hyperinflammation and multiple organ dysfunction syndrome (MODS). The intestinal fatty acid-binding protein (I-FABP) is solely expressed in the intestine and is released extracellulary after tissue damage. This study evaluates the validity of I-FABP as an early biomarker to detect hemorrhagic shock and abdominal injury.

Patients and methods

Severely injured patients with an Injury Severity Score (ISS) ≥ 16 points and an age ≥ 18 years, admitted from January 2010 to December 2016, were included. Overall, 26 patients retrospectively presented with hemorrhagic shock to the emergency room (ER): 8 patients without abdominal injury (“HS noAbd”) and 18 patients with abdominal injury (“HS Abd”). Furthermore, 16 severely injured patients without hemorrhagic shock and without abdominal injury (“noHS noAbd”) were retrospectively selected as controls. Plasma I-FABP levels were measured at admission to the ER and up to 3 days posttraumatic (d1-d3).

Results

Median I-FABP levels were significantly higher in the “HS Abd” group compared with the “HS noAbd” group (28,637.0 pg/ml [IQR = 6372.4–55,550.0] vs. 7292.3 pg/ml [IQR = 1282.5–11,159.5], p < 0.05). Furthermore, I-FABP levels of both hemorrhagic shock groups were significantly higher compared with the “noHS noAbd” group (844.4 pg/ml [IQR = 530.0–1432.9], p < 0.05). The time course of I-FABP levels showed a peak on the day of admission with a subsequent decline in the post-traumatic course. Furthermore, significant correlations between I-FABP levels and clinical parameters of hemorrhagic shock, such as hemoglobin, lactate value, systolic blood pressure (SBP), and shock index, were found.

The optimal cut-off level of I-FABP for detection of hemorrhagic shock was 1761.9 pg/ml with a sensitivity of 85% and a specificity of 81%.

Conclusion

This study confirmed our previous observation that I-FABP might be used as a suitable early biomarker for the detection of abdominal injuries in general. In addition, I-FABP may also be a useful and a promising parameter in the diagnosis of hemorrhagic shock, because of reflecting low intestinal perfusion.

Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, Fernández-Mondéjar E, Hunt BJ, Komadina R, Nardi G, Neugebauer E, Ozier Y, Riddez L, Schultz A, Stahel PF, Vincent J-L, Spahn DR. Management of bleeding following major trauma: an updated European guideline. Crit Care. 2010;14:R52.PubMedPubMedCentralCrossRef

Baron BJ, Scalea TM. Acute blood loss. Emerg Med Clin North Am. 1996;14:35–55.PubMedCrossRef

Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, Gettings L, Linberg SE, Vary TC. Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med. 1991;19:231–43.PubMedCrossRef

Rixen D, Raum M, Holzgraefe B, Sauerland S, Nagelschmidt M, Neugebauer EA. A pig hemorrhagic shock model: oxygen debt and metabolic acidemia as indicators of severity. Shock. 2001;16:239–44.PubMedCrossRef

Harrois A, Baudry N, Huet O, Kato H, Lohez M, Ziol M, Duranteau J, Vicaut E. Synergistic deleterious effect of hypoxemia and hypovolemia on microcirculation in intestinal villi*. Crit Care Med. 2013;41:e376–84.PubMedCrossRef

Moore FA. The role of the gastrointestinal tract in postinjury multiple organ failure. Am J Surg. 2000;178:449–53.CrossRef

Thuijls G, de Haan J-J, Derikx JPM, Daissormont I, Hadfoune M, Heineman E, Buurman WA. Intestinal cytoskeleton degradation precedes tight junction loss following hemorrhagic shock. Shock. 2008;31:164–9.CrossRef

Derikx JPM, Poeze M, van Bijnen AA, Buurman WA, Heineman E. Evidence for intestinal and liver epithelial cell injury in the early phase of sepsis. Shock. 2007;28:544–8.PubMed

Deitch EA, Xu D, Kaise VL. Role of the gut in the development of injury- and shock induced SIRS and MODS: the gut-lymph hypothesis, a review. Front Biosci. 2006;11:520–8.PubMedCrossRef

10.

Berg RD. Bacterial translocation from the gastrointestinal tract. Adv Exp Med Biol. 2000;473:11–30.CrossRef

11.

Baumgart DC, Dignass AU. Intestinal barrier function. Curr Opin Clin Nutr Metab Care. 2002;5:685–94.PubMedCrossRef

12.

Fink MP, Delude RL. Epithelial barrier dysfunction: a unifying theme to explain the pathogenesis of multiple organ dysfunction at the cellular level. Crit Care Clin. 2005;21:177–96.PubMedCrossRef

13.

Van Leeuwen PA, Boermeester MA, Houdijk AP, Ferwerda CC, Cuesta MA, Meyer S, Wesdorp RI. Clinical significance of translocation. Gut. 1994;35:S28–34.PubMedPubMedCentralCrossRef

14.

Waydhas C, Nast-Kolb D, Jochum M, Trupka A, Lenk S, Fritz H, Duswald KH, Schweiberer L. Inflammatory mediators, infection, sepsis, and multiple organ failure after severe trauma. Arch Surg. 1992;127:460–7.PubMedCrossRef

15.

Keel M, Trentz O. Pathophysiology of polytrauma. Injury. 2005;36:691–709.PubMedCrossRef

16.

Glatz JF, van der Vusse GJ. Cellular fatty acid-binding proteins: their function and physiological significance. Prog Lipid Res. 1996;35:243–82.PubMedCrossRef

17.

Pelsers MMAL, Hermens WT, Glatz JFC. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005;352:15–35.PubMedCrossRef

18.

Chan CPY, Wan TSM, Watkins KL, Pelsers MMAL, Van der Voort D, Tang FPW, Lam KHK, Mill J, Yuan Y, Lehmann M, Hempel A, Sanderson JE, Glatz JFC, Renneberg R. Rapid analysis of fatty acid-binding proteins with immunosensors and immunotests for early monitoring of tissue injury. Biosens Bioelectron. 2004;20:2566–80.PubMedCrossRef

19.

Kokorin VA, Arefiev MN, Levchouk NN, Gordeev IG. Diagnostic value of qualitative bedside heart-type fatty acid-binding protein tests compared with cardiac troponin assays in patients with suspected acute coronary syndrome. Pol Arch Intern Med. 2018;128:623–5.PubMed

20.

Sonmez BM, Ozturk D, Yilmaz F, Altinbilek E, Kavalci C, Durdu T, Hakbilir O, Turhan T, Ongar M. Bedside heart type fatty acid binding protein (H-FABP): is an early predictive marker of cardiac syncope. J Pak Med Assoc. 2015;65:1156–60.PubMed

21.

Lieberman JM, Sacchettini J, Marks C, Marks WH. Human intestinal fatty acid binding protein: report of an assay with studies in normal volunteers and intestinal ischemia. Surgery. 1997;121:335–42.PubMedCrossRef

22.

Pelsers MMAL, Namiot Z, Kisielewski W, Namiot A, Januszkiewicz M, Hermens WT, Glatz JFC. Intestinal-type and liver-type fatty acid-binding protein in the intestine. Tissue distribution and clinical utility. Clin Biochem. 2003;36:529–35.PubMedCrossRef

23.

Heida FH, Hulscher JBF, Schurink M, Timmer A, Kooi EMW, Bos AF, Bruggink JLM, Kasper DC, Pones M, Benkoe T. Intestinal fatty acid-binding protein levels in necrotizing enterocolitis correlate with extent of necrotic bowel: results from a multicenter study. J Pediatr Surg. 2014;50:1115–8.PubMedCrossRef

24.

Kanda T, Tsukahara A, Ueki K, Sakai Y, Tani T, Nishimura A, Yamazaki T, Tamiya Y, Tada T, Hirota M, Hasegawa J, Funaoka H, Fujii H, Hatakeyama K. Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study. J Gastroenterol. 2011;46:492–500.PubMedCrossRef

25.

Shi H, Wu B, Wan J, Liu W, Su B. The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia. Clin Res Hepatol Gastroenterol. 2015;39:373–8.PubMedCrossRef

26.

Cronk DR, Houseworth TP, Cuadrado DG, Herbert GS, McNutt PM, Azarow KS. Intestinal fatty acid binding protein (I-FABP) for the detection of strangulated mechanical small bowel obstruction. Curr Surg. 2006;63:322–5.PubMedCrossRef

27.

Voth M, Holzberger S, Auner B, Henrich D, Marzi I, Relja B. I-FABP and L-FABP are early markers for abdominal injury with limited prognostic value for secondary organ failures in the post-traumatic course. Clin Chem Lab Med. 2014;53:771–80.

28.

Voth M, Duchene M, Auner B, Lustenberger T, Relja B, Marzi I. I-FABP is a novel marker for the detection of intestinal injury in severely injured trauma patients. World J Surg. 2017;41:3120–7.PubMedCrossRef

29.

Relja B, Szermutzky M, Henrich D, Maier M, de Haan J-J, Lubbers T, Buurman WA, Marzi I. Intestinal-FABP and liver-FABP: novel markers for severe abdominal injury. Acad Emerg Med. 2010;17:729–35.PubMedCrossRef

30.

Elm von E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;12:1495–9.CrossRef

31.

Baker SP, O'Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.PubMedCrossRef

32.

Nast-Kolb D, Waydhas C, Kastl S, Duswald KH, Schweiberer L. The role of an abdominal injury in follow-up of polytrauma patients. Chirurg. 1993;64:552–9.PubMed

33.

Clark JA, Coopersmith CM. Intestinal crosstalk: a new paradigm for understanding the gut as the “motor” of critical illness. Shock. 2007;28:384–93.PubMedPubMedCentralCrossRef

34.

Malinoski DJ, Patel MS, Yakar DO, Green D, Qureshi F, Inaba K, Brown CVR, Salim A. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma. 2010;69:84–7.PubMedCrossRef

35.

Niederee MJ, Byrnes MC, Helmer SD, Smith RS. Delay in diagnosis of hollow viscus injuries: effect on outcome. Am Surg. 2003;69(4):293-9.

36.

Shebrain S, Zelada J, Lipsky AM, Putnam B. Mesenteric injuries after blunt abdominal trauma: delay in diagnosis and increased morbidity. Am Surg. 2006;72:955–61.PubMed

37.

Sung CK, Kim KH. Missed injuries in abdominal trauma. J Trauma. 1996;41:276–82.PubMedCrossRef

38.

Timmermans K, Sir Ö, Kox M, Vaneker M, de Jong C, Gerretsen J, Edwards M, Scheffer GJ, Pickkers P. Circulating iFABP levels as a marker of intestinal damage in trauma patients. Shock. 2014;43:117–20.CrossRef

39.

de Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve J-W, Marzi I, Buurman WA. Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study. Crit Care. 2009;13:R86.PubMedPubMedCentralCrossRef

40.

Derikx JPM, Schellekens DHSM, Acosta S. Serological markers for human intestinal ischemia: a systematic review. Best Pract Res Clin Gastroenterol. 2017;31:69–74.PubMedCrossRef

41.

Powell A, Armstrong P. Plasma biomarkers for early diagnosis of acute intestinal ischemia. Semin Vasc Surg. 2015;27:170–5.CrossRef

42.

Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med. 2016;374:959–68.PubMedCrossRef

43.

Surgeons CACO: American College of Surgeons Committee on Trauma: Hemorrhagic Shock. In: American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Student Course Manual Tenth Edition. Chicago: 2018. p. 48-54.

44.

Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma. 1988;28:1464–7.PubMedCrossRef

45.

Huckabee WE. Abnormal resting blood lactate. Am J Med. 1961;30:840.PubMedCrossRef

46.

Davis JW, Shackford SR, Holbrook TL. Base deficit as a sensitive indicator of compensated shock and tissue oxygen utilization. Surg Gynecol Obstet. 1991;173:473–6.PubMed

47.

Davis JW, Parks SN, Kaups KL, Gladen HE, O'Donnell-Nicol S. Admission base deficit predicts transfusion requirements and risk of complications. J Trauma. 1996;41:769–74.PubMedCrossRef

48.

Broder G, Weil MH. Excess lactate: an index of reversibility of shock in human patients. Science. 1964;143(3613):1457-9.PubMedCrossRef

Title: Is I-FABP not only a marker for the detection abdominal injury but also of hemorrhagic shock in severely injured trauma patients?
Authors: Maika Voth
Thomas Lustenberger
Borna Relja
Ingo Marzi
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Shock
Shock
Abdominal Trauma
Biomarkers
Published in: World Journal of Emergency Surgery / Issue 1/2019
Electronic ISSN: 1749-7922
DOI: https://doi.org/10.1186/s13017-019-0267-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is I-FABP not only a marker for the detection abdominal injury but also of hemorrhagic shock in severely injured trauma patients?

Abstract

Background

Patients and methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Patients and methods

Results

Conclusion

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