title: Intestinal Fatty Acid Binding Protein: A Sensitive Marker in Abdominal Surgery and Abdominal Infection.
abstract: BACKGROUND
  Intestinal fatty acid binding protein (iFABP) is elevated in plasma by intestinal injury. We investigated the influence of surgical trauma and severe sepsis caused by abdominal and pulmonary infection on plasma iFABP concentrations.
  
  
  METHODS
  Seventy-nine patients were included in this prospective observational study: 31 patients before elective major abdominal surgery (EMS), 33 patients with severe sepsis on admission to the intensive care unit (ICU), and 15 healthy volunteers who served as controls. Blood samples were taken before and after surgery for a period up to 5 d.
  
  
  RESULTS
  Prior to surgery, EMS patients had increased iFABP concentrations in those patients with intestinal cancer compared with patients without intestinal cancer (217 pg/mL, interquartile range [IQR] I-III 100-369 pg/mL versus 79 pg/mL, IQR I-III: 0-182 pg/mL; p<0.01) and with controls (114 pg/mL, IQR I-III: 103-124 pg/mL; p<0.01). Surgical trauma increased iFABP levels in patients without intestinal cancer (240 pg/mL, IQR I-III 111-305 pg/mL; p<0.01). Within 24 h after surgery, iFABP levels decreased to normal values. Patients with severe sepsis of abdominal origin had elevated concentrations compared with controls (324 pg/mL [IQR I-III 0-649 pg/mL]; p=0.05); in patients with pneumonia, iFABP levels were not significantly increased. Discrimination between intestinal- and pulmonary-induced sepsis was low (area under the curve [AUC] 0.693; 95% confidence interval 0.512-0.874).
  
  
  CONCLUSIONS
  Surgical trauma and severe sepsis lead to elevated iFABP concentrations. However, intestinal malignant disease and in some patients severe sepsis caused by pneumonia also resulted in elevated iFABP concentrations. The results support the idea that epithelial injury of many causes leads to elevated concentrations of iFABP. The value of iFABP for differentiating pulmonary from intestinal sepsis is limited.
authors.affiliation: 1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Tobias M
authors.initials: TM
authors.lastname: Bingold
authors.affiliation: 2Department of Haematology/Oncology, University Hospital Grosshadern, University of Munich, Munich, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Franck
authors.affiliation: 3Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Katharina
authors.initials: K
authors.lastname: Holzer
authors.affiliation: 1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Kai
authors.initials: K
authors.lastname: Zacharowski
authors.affiliation: 3Department of General and Visceral Surgery, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Wolf O
authors.initials: WO
authors.lastname: Bechstein
authors.affiliation: 4Department of Anesthesiology, Clinic for Plastic and Aesthetic Surgery, Heidelberg Proaesthetic GmbH, Heidelberg, Germany.
authors.forename: Heimo
authors.initials: H
authors.lastname: Wissing
authors.affiliation: 1Department of Anaesthesiology, Intensive Care Medicine and Pain Therapy, University Hospital Frankfurt, Frankfurt, Germany.
authors.forename: Bertram
authors.initials: B
authors.lastname: Scheller
mesh_terms: D000008:Abdominal Neoplasms / Q000473:pathology*; D000368:Aged; D015415:Biomarkers / Q000097:blood*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D050556:Fatty Acid-Binding Proteins / Q000097:blood*; D005260:Female; D006801:Humans; D059413:Intraabdominal Infections / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry; D011446:Prospective Studies; D012141:Respiratory Tract Infections / Q000473:pathology; D018805:Sepsis / Q000473:pathology*
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins