Acute intestinal failure in critically ill patients: is plasma citrulline the right marker?

Abstract

On the one hand, small bowel ischemia is related to acute reduction of enterocyte mass and loss of gut barrier function by epithelial lifting of villi. On the other hand, systemic inflammatory response syndrome (SIRS) and sepsis could be linked to an acute dysfunction of enterocytes without enterocyte reduction. Citrulline is an amino acid mainly synthesized by small bowel enterocytes. Various contexts of chronic and acute reduction of enterocyte mass have been correlated with low plasma citrulline concentration. Critically ill patients with shock have an acute reduction of enterocyte mass and reduced gut citrulline synthesis, leading to a low plasma citrulline concentration. Acute intestinal failure could be defined as an acute reduction of enterocyte mass and/or acute dysfunction of enterocytes, associated or not with loss of gut barrier function. The influence of SIRS and acute renal failure on plasma citrulline concentration and the value of this concentration as an indicator of acute intestinal failure in critically ill patients must be further evaluated.

Remediation of Hemorrhagic Shock-Induced Intestinal Barrier Dysfunction by Treatment with Diphenyldihaloketones EF24 and CLEFMA

“…As such, the estimation of plasma citrulline levels is being debated as a clinical marker of acute intestinal failure in critically ill patients (Piton et al, 2011). It is also a surrogate marker for estimating nitric oxide production by nitric oxide synthase activity.…”

Acute mesenteric ischemia: Do biomarkers contribute to diagnosis?

“…Akut vagy krónikus veseelégtelenséggel járó ál-lapotokban, valamint az enterocyták számának csökke-nése esetén alacsony citrullinszint mérhető. A citrullin plazmakoncentrációja tehát egy olyan dinamikusan vál-tozó paraméter, amellyel akut helyzetben a funkcionáló bélhámsejtek számára következtethetünk (hasonlóan az V-ös faktorhoz a máj esetén) [37].…”

Induced Hypothermia Preserves the Functional Enterocyte Mass in A Porcine Multiple Trauma Model

“…In haemorrhagic shock, splanchnic hypoperfusion and subsequent alterations of the intestinal mucosa seem to be responsible for the derangement of the gut barrier and subsequent bacterial translocation (4-7). Particularly in the small bowel, gastrointestinal dysfunction has been linked to an acute reduction of enterocyte mass (8). Furthermore, a reperfused intestine contributes to an early systemic inflammatory response syndrome (SIRS) with the release of proinflammatory mediators leading to distant organ damages (2).…”

“…Plasma citrulline and Òintestinal Fatty Acid Binding ProteinÓ (iFABP) have been suggested as reliable biomarkers for assessing gut injury (8)(9)(10)(11)(12)(13)(14). Citrulline is an amino acid synthesized in small bowel enterocytes from glutamine and is constantly released to the blood (8).…”