Circulating iFABP Levels as a Marker of Intestinal Damage in Trauma Patients

Abstract

Both the initial trauma and the subsequent hemodynamic instability may contribute to intestinal damage, which is of great importance in (immunological) posttrauma complications. This study assesses intestinal damage using the biomarker intestinal Fatty Acid Binding Protein (iFABP) in trauma patients during the first days of their hospital admission and the risk factors involved. Plasma iFABP levels were measured in blood samples obtained from adult multiple trauma patients (n = 93) at the trauma scene by the Helicopter Emergency Medical Services, at arrival at the emergency department (ED), and at days 1, 3, 5, 7, 10, and 14 after trauma and related to injury severity and hemodynamic parameters. Plasma iFABP concentrations showed highest levels immediately after trauma at time points Helicopter Emergency Medical Services and ED. Nonsurvivors demonstrated higher iFABP levels at the ED compared with survivors. Furthermore, iFABP values at the ED correlated with Injury Severity Scores, and patients suffering from abdominal trauma demonstrated significantly higher iFABP concentrations in comparison with patients with other types of trauma or healthy controls. Also, patients presenting with a mean arterial pressure (MAP) less than 70 mmHg at the ED demonstrated significantly higher plasma iFABP concentrations in comparison with patients with a normal (70-99 mmHg) or high (>100 mmHg) MAP or healthy controls. Finally, patients with a low hemoglobin (Hb) (<80% of reference value) displayed significantly higher iFABP concentrations in comparison with patients with a normal Hb or healthy controls. Plasma iFABP levels, indicative of intestinal injury, are increased immediately after trauma in patients with abdominal trauma, low MAP, or low Hb and are related to the severity of the trauma. As intestinal injury is suggested to be related to late complications, such as multiorgan dysfunction syndrome or sepsis in trauma patients, strategies to prevent intestinal damage after trauma could be of benefit to these patients.

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

“…Surprisingly, we were not able to confirm results from other literature, which found that elevated iFABP correlates with both greater enterocyte damage and elevated lactate levels (12,13). Although MAP and Hb are independently associated with increased iFABP levels (13), these parameters cannot explain any differences as they did not vary between the trauma groups.…”

“…Therefore Piton et alÕs definition, which was developed from work with a mixed critically ill patient cohort, might not be applicable in this posttraumatic setting. Previously, iFABP has been described as increasing early after trauma (13) and as normalising rapidly between day two and three after admission (29). Therefore the increase of iFABP in TH might be due to a reduced metabolism with a prolonged increase under hypothermic conditions (20).…”

“…iFABP is a cytoplasmic protein, exclusively expressed by enterocytes (14). While iFABP should not be detectable in healthy individuals, it is released into the blood as a consequence of enterocyte ischemia and damage (13,14).…”

“…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).…”

Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

“…Second, I-FABP can be elevated in severe abdominal trauma to the diaphragm, liver, and spleen, without HVI. [13,15,16] I-FABP levels are significantly higher in patients with abdominal AIS ≥3 than in those with abdominal AIS <3. This might indicate that a direct blow to the abdomen affects I-FABP levels.…”