Usefulness of Intestinal Fatty Acid-Binding Protein in Predicting Strangulated Small Bowel Obstruction

Kittaka, Hirotada; Akimoto, Hiroshi; Takeshita, Hitoshi; Funaoka, Hiroyuki; Hara, Hiroshi; Okamoto, Masao; Kobata, Hitoshi; Ohishi, Yasuo

doi:10.1371/journal.pone.0099915

Cited by 33 publications

(36 citation statements)

References 42 publications

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“…The concentration of CRP, a plasma protein, rises dramatically as a result of cytokine-mediated responses to most forms of infection, inflammation, and tissue injury. [27] In this study, serum CRP was not significantly different between the NSG and SG, as was found in the study of Kittaka et al [9] Also, Simon et al reported that, for bacterial infections, serum CRP has little sensitivity and specificity. [28] We feel that further study is needed to determine the usefulness of CRP in this regard.…”

Section: Discussionsupporting

confidence: 76%

“…However, other reports found no difference in terms of time of symptom onset to ED arrival between SG and NSG. [8,9] …”

Section: Discussionmentioning

confidence: 99%

“…[6,7] Some studies have reported that inflammatory markers such as procalcitonin or intestinal fatty acid-binding protein might be useful for predicting strangulated bowel obstruction. [8,9] Enhanced computed tomography (CT) is a useful tool for differentiating between simple and strangulated bowel obstruction with a high rate of accuracy (73–93%). [10,11] However, the sensitivity and specificity of an intestinal ischemia diagnosis by experienced gastrointestinal radiologists blinded to patient identification and all clinical data range from 15% to 30% and 91% to 94%, respectively.…”

Section: Introductionmentioning

confidence: 99%

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The use of delta neutrophil index and myeloperoxidase index as diagnostic predictors of strangulated mechanical bowel obstruction in the emergency department

Sung

Lee

et al. 2016

Medicine

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Early detection of bowel strangulation is difficult in patients with mechanical bowel obstruction (MBO). There have been no previous reports of predicting strangulation in MBO cases using the delta neutrophil index (DNI), which is a measure of the proportion of circulating immature granulocytes, or the myeloperoxidase index (MPXI), which is a measure of serum myeloperoxidase level. Therefore, we evaluated differences in initial DNI and MPXI upon presentation at the emergency department (ED) according to strangulation presence in MBO patients.This is a retrospective observational study of consecutive patients older than 18 years who were diagnosed with MBO over a 31-month period. MBO was ultimately confirmed by computed tomography (CT) findings by a radiology specialist. Patients were categorized by a strangulation group (SG) and nonstrangulation group (NSG). The SG was defined by surgical and pathologic findings after the surgical operation. Initial serum counts of white blood cells and neutrophils, C-reactive protein levels, and DNI and MPXI scores were investigated in the ED.Fifteen of 160 patients were allocated to the SG (9.4%), and among the inflammatory markers, median initial DNI value was the only one that was significantly higher in the SG (0% vs 3.2%, P = 0.003). Although the areas under the receiver operation characteristic (ROC) curves for initial DNI and CT for differentiating strangulated from nonstrangulated bowel obstruction were 0.713 (95% confidence interval [CI]: 0.636–0.782) and 0.883 (95% CI: 0.823–0.928), respectively; there was no significant difference between DNI and CT (P = 0.147). The area under the curve (AUC) for predicting strangulated bowel disease from a combination of initial DNI score and CT findings (0.983, 95% CI: 0.948–0.997) was higher than the AUC for CT alone, although the difference was not significant (P = 0.052).In conclusion, initial DNI, which was performed in the ED, was found to be significantly higher in the SG than in the NSG. Initial DNI might be a useful additional parameter for improving the prediction accuracy of CT.

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Section: Discussionsupporting

confidence: 76%

“…However, other reports found no difference in terms of time of symptom onset to ED arrival between SG and NSG. [8,9] …”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use of delta neutrophil index and myeloperoxidase index as diagnostic predictors of strangulated mechanical bowel obstruction in the emergency department

Sung

Lee

et al. 2016

Medicine

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“…Recently, a retrospective study 34 has shown that increase in I-FABP levels in patients with small bowel obstruction can be used to predict strangulation. The I-FABP can be increased with dynamic recycling of enterocytes during ischemia or strangulation, but I-FABP measurement requires a long period of time, while measurement of serum CRP and serum D-lactate can be done in a short span of time.…”

Section: Discussionmentioning

confidence: 99%

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Pal¹,

Ansari²,

Islam³

2016

Panamerican Journal of Trauma, Critical Care &Amp; Emergency Surgery

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Introduction: Serum C-reactive protein (CRP) and D-lactate have been proposed as markers of intestinal ischemia. The purpose of this prospective observational study is to find whether serum CRP and serum D-lactate can help in predicting strangulation in cases of acute intestinal obstruction. Materials and methods:A total of 50 consecutive patients were included in the study after excluding patients of comorbid medical illness and patients with findings other than obstruction or strangulation. The serum values of CRP and D-lactate were measured and compared between obstruction with strangulation and obstruction without strangulation. Receiver operating characteristic (ROC) curve was drawn and cutoff values for the diagnosis of strangulation were calculated along with calculation of sensitivity, specificity, positive predictive values (PPVs), and negative predictive values (NPVs).Results: A total of 14 patients who were diagnosed with strangulated bowel obstruction had significantly higher values of serum CRP and D-lactate when compared with 36 patients with simple bowel obstruction (116 vs 40 mg/L and 5.4 vs 2.7 mmol/L respectively, p < 0.05). Using ROC analysis, the area under the curve of serum CRP and D-lactate was found to be 0.785 and 0.775 respectively, for bowel strangulation. Using a cutoff value of 60 mg/L for CRP, the sensitivity, specificity, PPV, and NPV were 87.5, 58.3, 48.3, 91.3% respectively. Using a cutoff value of 4.5 mmol/L for D-lactate, the sensitivity, specificity, PPV, and NPV were 75.0, 69.4, 52.7, 86.2% respectively. Conclusion:Serum CRP and D-lactate can be useful and reasonable markers for predicting strangulation in cases of acute intestinal obstruction in an emergency setting.

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“…Kittaka et al [53] found that serum I-FABP concentrations were significantly increased in patients with strangulated bowel obstruction (n = 21; 18.5 ng/mL), as compared with patients with simple obstruction (n = 16; 1.6 ng/mL).…”

Section: Fatty Acid-binding Proteins (Fabp) Biomarkers Of Villi Injurymentioning

confidence: 98%

Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far

Peoc’h

Nuzzo

Guedj

et al. 2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Acute intestinal ischemic injury (i3) is a lifethreatening condition with disastrous prognosis, which is currently difficult to diagnose at the early stages of the disease; a rapid diagnosis is mandatory to avoid irreversible ischemia, extensive bowel resection, sepsis and death. The overlapping protein expression of liver and gut related to the complex physiopathology of the disease, the heterogeneity of the disease and its relative rarity could explain the lack of a useful early biochemical marker of i3. Apart from non-specific biological markers of thrombosis, hypoxia inflammation, and infection, several more specific biomarkers in relation with the gut barrier dysfunction, the villi injury and the enterocyte mass have been used in the diagnosis of acute i3. It includes particularly D-lactate, intestinal fatty acid-binding protein (FABP) and citrulline. Herein, we will discuss leading publications concerning these historical markers that point out the main limitations reagrding their use in routine clinical practice. We will also introduce the first and limited results arising from omic studies, underlying the remaining effort that needs to be done in the field of acute i3 biological diagnosis, which remains a challenge.

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Usefulness of Intestinal Fatty Acid-Binding Protein in Predicting Strangulated Small Bowel Obstruction

Cited by 33 publications

References 42 publications

The use of delta neutrophil index and myeloperoxidase index as diagnostic predictors of strangulated mechanical bowel obstruction in the emergency department

The use of delta neutrophil index and myeloperoxidase index as diagnostic predictors of strangulated mechanical bowel obstruction in the emergency department

Combination of Serum C-reactive Protein and D-lactate: Predictors of Strangulation in Intestinal Obstruction

Diagnosis biomarkers in acute intestinal ischemic injury: so close, yet so far

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