Early diagnosis of intestinal ischemia using urinary and plasma fatty acid binding proteins.
OBJECTIVE
This study aims at improving diagnosis of intestinal ischemia, by measuring plasma and urinary fatty acid binding protein (FABP) levels.


METHODS
Fifty consecutive patients suspected of intestinal ischemia were included and blood and urine were sampled at time of suspicion. Plasma and urinary concentrations of intestinal FABP (I-FABP), liver FABP (L-FABP) and ileal bile acid binding protein (I-BABP) were measured using enzyme-linked immunosorbent assays.


RESULTS
Twenty-two patients suspected of intestinal ischemia were diagnosed with intestinal ischemia, 24 patients were diagnosed with other diseases, and 4 patients were excluded from further analysis fulfilling exclusion criteria. Median plasma concentrations of I-FABP and L-FABP and urinary concentrations of all 3 markers were significantly higher in patients with proven intestinal ischemia than in patients suspected of intestinal ischemia with other final diagnoses (plasma I-FABP; 653 pg/mL vs. 109 pg/mL, P = 0.02, plasma L-FABP; 117 ng/mL vs. 25 ng/mL, P = 0.006, urine I-FABP; 3377 pg/mL vs. 115 pg/mL, P = 0.001, urine L-FABP; 1,199 ng/mL vs. 37 ng/mL, P =0.004, urine I-BABP; 48.6 ng/mL vs. 0.6 ng/mL, P = 0.002). Positive and negative likelihood ratios significantly increased positive posttest probability and decreased negative posttest probability on intestinal ischemia. In patients with intestinal ischemia a trend to higher plasma I-BABP levels was observed when the ileum was involved (18.4 ng/mL vs. 2.9 ng/mL, P = 0.05).


CONCLUSIONS
Plasma and especially urinary I-FABP and L-FABP levels and urinary I-BABP levels can improve early diagnosis of intestinal ischemia. Furthermore, plasma I-BABP levels can help in localizing ileal ischemia.
Department of Surgery, Maastricht University Medical Center and NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht, The Netherlands.
Geertje
G
Thuijls
Kim
K
van Wijck
Joep
J
Grootjans
Joep P M
JP
Derikx
Annemarie A
AA
van Bijnen
Erik
E
Heineman
Cornelis H C
CH
Dejong
Wim A
WA
Buurman
Martijn
M
Poeze
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002648:Child; D042241:Early Diagnosis; D050556:Fatty Acid-Binding Proteins / Q000097:blood* / Q000652:urine*; D005260:Female; D005768:Gastrointestinal Hormones / Q000652:urine; D006801:Humans; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D055815:Young Adult
D015415:Biomarkers; C493319:FABP1 protein, human; D050556:Fatty Acid-Binding Proteins; D005768:Gastrointestinal Hormones; C057275:fatty acid-binding protein 6