title: Gut-associated biomarkers L-FABP, I-FABP, and TFF3 and LIT score for diagnosis of surgical necrotizing enterocolitis in preterm infants.
abstract: OBJECTIVE
  To evaluate the use of gut barrier proteins, liver-fatty acid binding protein (L-FABP), intestinal-fatty acid binding protein (I-FABP), and trefoil factor 3 (TFF3), as biomarkers for differentiating necrotizing enterocolitis (NEC) from septicemic/control infants and to identify the most severely affected surgical NEC from nonsurgical NEC infants.
  
  
  BACKGROUND
  Clinical features and routine radiologic investigations have low diagnostic utilities in identifying surgical NEC patients.
  
  
  METHODS
  The diagnostic utilities of individual biomarkers and the combination of biomarkers, the LIT score, were assessed among the NEC (n = 20), septicemia (n = 40), and control groups (n = 40) in a case-control study for the identification of proven NEC and surgical NEC infants.
  
  
  RESULTS
  Plasma concentrations of all gut barrier biomarkers and the LIT score were significantly higher in the NEC than in the septicemia or control group (P < 0.01). Using median values of biomarkers and the LIT score in the NEC group as cutoff values for identifying NEC from septicemic/control cases, all had specificities of 95% or more and sensitivities of 50%. Significantly higher levels of biomarkers and the LIT score were found in infants with surgical NEC than in nonsurgical NEC cases (P ≤ 0.02). The median LIT score of 4.5 identified surgical NEC cases with sensitivity and specificity of 83% and 100%%, respectively. A high LIT score of 6 identified nonsurvivors of NEC with sensitivity and specificity of 78% and 91%, respectively.
  
  
  CONCLUSIONS
  The LIT score can effectively differentiate surgical NEC from nonsurgical NEC infants and nonsurvivors of NEC from survivors at the onset of clinical presentation. Frontline neonatologists and surgeons may, therefore, target NEC infants who are most in need of close monitoring and those who may benefit from early surgical intervention.
authors.affiliation: From the Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
authors.forename: Eddy W Y
authors.initials: EW
authors.lastname: Ng
authors.forename: Terence C W
authors.initials: TC
authors.lastname: Poon
authors.forename: Hugh S
authors.initials: HS
authors.lastname: Lam
authors.forename: Hon M
authors.initials: HM
authors.lastname: Cheung
authors.forename: Terence P Y
authors.initials: TP
authors.lastname: Ma
authors.forename: Kathy Y Y
authors.initials: KY
authors.lastname: Chan
authors.forename: Raymond P O
authors.initials: RP
authors.lastname: Wong
authors.forename: Kam T
authors.initials: KT
authors.lastname: Leung
authors.forename: Melody M T
authors.initials: MM
authors.lastname: Lam
authors.forename: Karen
authors.initials: K
authors.lastname: Li
authors.forename: Pak C
authors.initials: PC
authors.lastname: Ng
mesh_terms: D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D003937:Diagnosis, Differential; D020345:Enterocolitis, Necrotizing / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D041981:Gastrointestinal Tract; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D010455:Peptides / Q000097:blood*; D018805:Sepsis / Q000097:blood / Q000175:diagnosis; D000071165:Trefoil Factor-3
chemical_list: D015415:Biomarkers; C493319:FABP1 protein, human; C493404:FABP2 protein, human; D050556:Fatty Acid-Binding Proteins; D010455:Peptides; C082495:TFF3 protein, human; D000071165:Trefoil Factor-3