title: I-FABP and L-FABP are early markers for abdominal injury with limited prognostic value for secondary organ failures in the post-traumatic course.
abstract: BACKGROUND
  Trauma patients sustaining abdominal trauma exhibit high risk of organ failure and/or sepsis aggravating morbidity and mortality during the post-traumatic course. The present study re-evaluates L- and I-FABPs (small fatty acid binding proteins) as early biomarkers for abdominal injury (AI) in a large cohort of patients and analyzes their potential as indicators of specific organ failure and their association with sepsis and/or mortality in the post-traumatic course.
  
  
  METHODS
  This prospective study included 134 multiply traumatized patients (ISS≥16). Fifty-nine had AI (abbreviated AI Scale, AISAbd≥3) and 75 had no AI (noAI). Twenty healthy volunteers served as controls. Plasma I- and L-FABP levels were measured at the admittance to the emergency room (d0) and up to 10 days daily (d1-d10) using ELISA. Sepsis, organ failure, multiple organ failure (MOF) and mortality were assessed.
  
  
  RESULTS
  Median L- and I-FABP in the AI-group [258 (IQR=71-500) ng/mL and 328 (IQR=148-640) pg/mL, respectively] were higher compared to noAI-group [30 (IQR=18-50) ng/mL and 60 (IQR=40-202) pg/mL, p>0.05] on d0. Sensitivity and specificity to detect AI were 80% and 75% for L-FABP, 78% and 62% for I-FABP. Both FABPs decline with the post-traumatic course to control levels. On d0 and d1, FABPs correlate with the Sepsis-related Organ Failure Assessment (SOFA) score of the following day (d0: ρ:0.33, ρ:0.46, d1: ρ:0.48, ρ:0.35). No other correlations were found. Eight percent of all patients developed sepsis, 18% pneumonia, 4% urinary tract infection, 3% acute kidney failure and one MOF. FABPs correlated neither with Simplifed Acute Physiology Score (SAPS)-II nor to sepsis. All patients with acute kidney failure demonstrated enhanced L-FAPB levels before the increase of serum creatinine levels.
  
  
  CONCLUSIONS
  Our results confirm the potential of L- and I-FABP to indicate abdominal injuries initially after trauma. Except L-FABP as indicator of acute kidney failure both FABPs have to be further evaluated as predictors for other organ failures, sepsis and/or mortality.
authors.forename: Maika
authors.initials: M
authors.lastname: Voth
authors.forename: Sebastian
authors.initials: S
authors.lastname: Holzberger
authors.forename: Birgit
authors.initials: B
authors.lastname: Auner
authors.forename: Dirk
authors.initials: D
authors.lastname: Henrich
authors.forename: Ingo
authors.initials: I
authors.lastname: Marzi
authors.forename: Borna
authors.initials: B
authors.lastname: Relja
mesh_terms: D000007:Abdominal Injuries / Q000097:blood* / Q000150:complications*; D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000150:complications* / Q000175:diagnosis* / Q000401:mortality; D011379:Prognosis; D018805:Sepsis / Q000150:complications
chemical_list: D015415:Biomarkers; C493319:FABP1 protein, human; C493404:FABP2 protein, human; D050556:Fatty Acid-Binding Proteins