title: Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients.
abstract: OBJECTIVE
  Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to explore intestinal failure biomarkers in post-cardiac arrest patients and to correlate them with endotoxemia.
  
  
  METHODS
  Following resuscitation after cardiac arrest, 21 patients were prospectively studied. Urinary intestinal fatty acid-binding protein (IFABP), which marks intestinal permeability, plasma citrulline, which reflects the functional enterocyte mass, and whole blood endotoxin were measured at admission, days 1-3 and 6. We explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values.
  
  
  RESULTS
  IFABP was extremely high at admission and normalized at D3 (6668 pg/mL vs 39 pg/mL, p=0.01). Lowest median of citrulline (N=20-40 μmol/L) was attained at D2 (11 μmol/L at D2 vs 24 μmol/L at admission, p=0.01) and tended to normalize at D6 (21 μmol/L). During ICU stay, 86% of patients presented a detectable endotoxemia. Highest endotoxin level was positively correlated with highest IFABP level (R(2)=0.31, p=0.01) and was inversely correlated with lowest plasma citrulline levels (R(2)=0.55, p<0.001). Endotoxin levels increased between admission and D2 in patients with post-resuscitation shock, whereas it decreases in patients with no shock (median +0.33 EU vs -0.19 EU, p=0.03). Highest endotoxin level was positively correlated with D3 SOFA score (R(2)=0.45, p=0.004).
  
  
  CONCLUSIONS
  Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post-resuscitation shock and organ failure.
authors: Medical Intensive Care Unit, Groupe Hospitalier Broca Cochin Hotel-Dieu, AP-HP, 27 rue du Faubourg Saint Jacques, 75679 Paris Cedex 14, France.
authors: D
authors: D
authors: Grimaldi
authors: E
authors: E
authors: Guivarch
authors: N
authors: N
authors: Neveux
authors: J
authors: J
authors: Fichet
authors: F
authors: F
authors: Pène
authors: J-S
authors: JS
authors: Marx
authors: J-D
authors: JD
authors: Chiche
authors: L
authors: L
authors: Cynober
authors: J-P
authors: JP
authors: Mira
authors: A
authors: A
authors: Cariou
mesh_terms: D015415:Biomarkers / Q000378:metabolism*; D016887:Cardiopulmonary Resuscitation; D002851:Chromatography, High Pressure Liquid; D002956:Citrulline / Q000097:blood; D019446:Endotoxemia / Q000097:blood / Q000503:physiopathology; D004731:Endotoxins / Q000097:blood; D004797:Enzyme-Linked Immunosorbent Assay; D050556:Fatty Acid-Binding Proteins / Q000652:urine; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000378:metabolism; D007422:Intestines / Q000503:physiopathology*; D049449:Luminescence; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000378:metabolism* / Q000628:therapy*; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D015415:Biomarkers; D004731:Endotoxins; D050556:Fatty Acid-Binding Proteins; D002956:Citrulline