title: Catecholamine use is associated with enterocyte damage in critically ill patients.
abstract: Small bowel damage is frequent but underdiagnosed among critically ill patients with shock. High catecholamine doses may have a deleterious effect on mesenteric blood flow. Plasma intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage, whereas plasma citrulline concentration is a marker of functional enterocyte mass. We hypothesized that high doses of catecholamines in critically ill patients may be associated with enterocyte damage. This study aimed to determine the link between catecholamine use and dose with enterocyte damage. This is a prospective observational study performed in a large regional university teaching hospital. Critically ill patients requiring epinephrine and/or norepinephrine at admission to a medical intensive care unit (ICU) were included, as well as controls not receiving catecholamines. We evaluated at admission plasma I-FABP and citrulline concentrations, abdominal perfusion pressure (APP), and variables relating to prognosis and treatment. Patients were categorized according to the quartiles of catecholamine dose at ICU admission. Sixty critically ill patients receiving catecholamines and 27 not receiving catecholamines were included. Plasma I-FABP was higher among patients receiving catecholamine than in controls. Among patients receiving catecholamines, a dose of 0.48 γ kg min or more at ICU admission was associated with a higher I-FABP concentration. A Sepsis-related Organ Failure Assessment score higher than 11 and plasma I-FABP more than 524 pg mL at ICU admission were independently associated with 28-day mortality (odds ratio, 4.0 [1.24-12.95] and odds ratio, 4.90 [1.44-16.6], respectively). Catecholamine use is associated with I-FABP elevation in critically ill patients. Critically ill patients receiving more than 0.48 γ kg min of epinephrine and/or norepinephrine at ICU admission have high I-FABP concentrations. This suggests that enterocyte damage reflects the severity of shock, and an adverse effect of catecholamines per se is possible.
authors.affiliation: *Medical Intensive Care Unit, University Hospital, Besançon, France, †Research Unit EA 3920 and SFR FED 4234, University of Franche Comté, Besançon, France, ‡Clinical Chemistry Unit, §Physiology Department, ∥Clinical Methodology Center, University Hospital, Besançon, France; and ¶Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Clayton, Australia.
authors.forename: Gaël
authors.initials: G
authors.lastname: Piton
authors.forename: Benoit
authors.initials: B
authors.lastname: Cypriani
authors.forename: Jacques
authors.initials: J
authors.lastname: Regnard
authors.forename: Cyrille
authors.initials: C
authors.lastname: Patry
authors.forename: Marc
authors.initials: M
authors.lastname: Puyraveau
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
mesh_terms: D000368:Aged; D001783:Blood Flow Velocity; D002395:Catecholamines / Q000009:adverse effects* / Q000097:blood / Q000627:therapeutic use*; D003422:Critical Care; D016638:Critical Illness; D020895:Enterocytes / Q000187:drug effects* / Q000473:pathology; D004837:Epinephrine / Q000008:administration & dosage; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007421:Intestine, Small / Q000187:drug effects* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000008:administration & dosage; D016017:Odds Ratio; D011379:Prognosis; D011446:Prospective Studies; D012772:Shock, Septic / Q000097:blood* / Q000503:physiopathology
chemical_list: D002395:Catecholamines; D050556:Fatty Acid-Binding Proteins; D009638:Norepinephrine; D004837:Epinephrine