Organ failure, infection, and the systemic inflammatory response syndrome are associated with elevated levels of urinary intestinal fatty acid binding protein: study of 100 consecutive patients in a surgical intensive care unit.
BACKGROUND
Intestinal mucosal ischemia and subsequent barrier dysfunction have been related to the development of organ dysfunction and death in the critically ill. We hypothesized that urine concentrations of intestinal fatty acid binding protein (IFABP), a sensitive marker of intestinal ischemia, might predict the development of the systemic inflammatory response syndrome (SIRS) and organ dysfunction.


METHODS
One hundred consecutive critically ill patients were prospectively studied for the development of infectious complications, organ dysfunction, and SIRS. Urine was collected daily for measurement of IFABP.


RESULTS
A total of 58 males and 42 females (mean age, 56 years; range,16-85 years) were studied. Of these 100 patients, 40 patients developed complications and 5 patients developed SIRS. IFABP was significantly elevated in all patients with SIRS, and IFABP levels peaked an average of 1.4 days (range, 0-7 days) before the diagnosis of SIRS.


CONCLUSIONS
Elevated concentrations of urine IFABP correlated with the clinical development of SIRS. Studies to assess the utility of IFABP as a predictor of organ dysfunction and SIRS in the critically ill are warranted.
Lieberman
J M
JM
Department of Organ Transplantation, Swedish Medical Center, Seattle, Washington, USA.
Marks
W H
WH
Cohn
S
S
Jaicks
R
R
Woode
L
L
Sacchettini
J
J
Fischer
B
B
Moller
B
B
Burns
G
G
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D002352:Carrier Proteins / Q000652:urine*; D003422:Critical Care; D000071438:Fatty Acid-Binding Protein 7; D050556:Fatty Acid-Binding Proteins; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000652:urine*; D007413:Intestinal Mucosa / Q000098:blood supply; D007511:Ischemia / Q000652:urine; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000652:urine*; D018996:Myelin P2 Protein / Q000652:urine*; D009363:Neoplasm Proteins; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D018746:Systemic Inflammatory Response Syndrome / Q000652:urine*; D013997:Time Factors; D025521:Tumor Suppressor Proteins
D015415:Biomarkers; D002352:Carrier Proteins; C107608:FABP7 protein, human; D000071438:Fatty Acid-Binding Protein 7; D050556:Fatty Acid-Binding Proteins; D018996:Myelin P2 Protein; D009363:Neoplasm Proteins; D025521:Tumor Suppressor Proteins