Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study.
BACKGROUND
Loss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma. Thus far, clinical data concerning the occurrence and significance of intestinal damage after trauma remain scarce. This study investigates whether early intestinal epithelial cell damage occurs in trauma patients and, if present, whether such cell injury is related to shock, injury severity and the subsequent inflammatory response.


METHODS
Prospective observational cohort study in 96 adult trauma patients. Upon arrival at the emergency room (ER) plasma levels of intestinal fatty acid binding protein (i-FABP), a specific marker for damage of differentiated enterocytes, were measured. Factors that potentially influence the development of intestinal cell damage after trauma were determined, including the presence of shock and the extent of abdominal trauma and general injury severity. Furthermore, early plasma levels of i-FABP were related to inflammatory markers interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP).


RESULTS
Upon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01). The elevation of i-FABP was related to the extent of abdominal trauma as well as general injury severity (P < 0.05). Circulatory i-FABP concentrations at ER correlated positively with IL-6 and PCT levels at the first day (r2 = 0.19; P < 0.01 and r2 = 0.36; P < 0.001 respectively) and CRP concentrations at the second day after trauma (r2 = 0.25; P < 0.01).


CONCLUSIONS
This study reveals early presence of intestinal epithelial cell damage in trauma patients. The extent of intestinal damage is associated with the presence of shock and injury severity. Early intestinal damage precedes and is related to the subsequent developing inflammatory response.
de Haan
Jacco J
JJ
Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, 6229 ER, Maastricht, The Netherlands. jj.dehaan@ah.unimaas.nl
Lubbers
Tim
T
Derikx
Joep P
JP
Relja
Borna
B
Henrich
Dirk
D
Greve
Jan-Willem
JW
Marzi
Ingo
I
Buurman
Wim A
WA
D000007:Abdominal Injuries / Q000097:blood; D000328:Adult; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D020895:Enterocytes / Q000378:metabolism*; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood* / Q000209:etiology* / Q000276:immunology; D008297:Male; D011446:Prospective Studies; D012720:Severity of Illness Index; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000150:complications; D014947:Wounds and Injuries / Q000097:blood* / Q000150:complications* / Q000276:immunology
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins