Circulating iFABP Levels as a marker of intestinal damage in trauma patients.
Both the initial trauma and the subsequent hemodynamic instability may contribute to intestinal damage, which is of great importance in (immunological) posttrauma complications. This study assesses intestinal damage using the biomarker intestinal Fatty Acid Binding Protein (iFABP) in trauma patients during the first days of their hospital admission and the risk factors involved. Plasma iFABP levels were measured in blood samples obtained from adult multiple trauma patients (n = 93) at the trauma scene by the Helicopter Emergency Medical Services, at arrival at the emergency department (ED), and at days 1, 3, 5, 7, 10, and 14 after trauma and related to injury severity and hemodynamic parameters. Plasma iFABP concentrations showed highest levels immediately after trauma at time points Helicopter Emergency Medical Services and ED. Nonsurvivors demonstrated higher iFABP levels at the ED compared with survivors. Furthermore, iFABP values at the ED correlated with Injury Severity Scores, and patients suffering from abdominal trauma demonstrated significantly higher iFABP concentrations in comparison with patients with other types of trauma or healthy controls. Also, patients presenting with a mean arterial pressure (MAP) less than 70 mmHg at the ED demonstrated significantly higher plasma iFABP concentrations in comparison with patients with a normal (70-99 mmHg) or high (>100 mmHg) MAP or healthy controls. Finally, patients with a low hemoglobin (Hb) (<80% of reference value) displayed significantly higher iFABP concentrations in comparison with patients with a normal Hb or healthy controls. Plasma iFABP levels, indicative of intestinal injury, are increased immediately after trauma in patients with abdominal trauma, low MAP, or low Hb and are related to the severity of the trauma. As intestinal injury is suggested to be related to late complications, such as multiorgan dysfunction syndrome or sepsis in trauma patients, strategies to prevent intestinal damage after trauma could be of benefit to these patients.
Departments of *Intensive Care Medicine, †Anesthesiology, and ‡Emergency Medicine, §Helicopter Emergency Medical Services, and ∥Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Kim
K
Timmermans
Özcan
Ö
Sir
Matthijs
M
Kox
Michiel
M
Vaneker
Carmen
C
de Jong
Jelle
J
Gerretsen
Michael
M
Edwards
Gert Jan
GJ
Scheffer
Peter
P
Pickkers
D000007:Abdominal Injuries / Q000097:blood / Q000503:physiopathology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000293:injuries*; D008875:Middle Aged; D009104:Multiple Trauma / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins