title: Enterocyte Damage: A Piece in the Puzzle of Post-Cardiac Arrest Syndrome.
abstract: Cardiac arrest is considered to be a cause of small bowel ischemia, but the consequences of cardiac arrest on the human small bowel have been rarely studied. Plasma citrulline concentration is a marker of functional enterocyte mass, and plasma intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to measure enterocyte biomarkers after cardiac arrest and to study the prognostic value of biomarker abnormalities. This is a prospective, observational, single-center study of patients admitted to the intensive care unit (ICU) for cardiac arrest, evaluating plasma citrulline and I-FABP concentrations at admission and after 24  h and variables according to the Utstein criteria. Variables according to 28-day Cerebral Performance Category score of 1 to 2 (good neurological outcome) versus 3 to 5 (poor neurological outcome) were compared. Sixty-nine patients with cardiac arrest of both cardiac and hypoxic origin were included. At ICU admission, plasma citrulline concentration was low in 65% and plasma I-FABP was elevated in 82% of the patients. After 24  h, plasma citrulline was low in 82% and I-FABP was normal in 60% of the patients. Patients with a poor neurological outcome had a lower plasma citrulline concentration and a higher I-FABP concentration at ICU admission. By multivariate analysis, plasma citrulline levels of 13.1  μmol L or less and I-FABP more than 260  pg mL were independently associated with a poor neurological outcome (odds ratio, 21.9 [2.2-215], and odds ratio, 13.6 [1.4-129], respectively). Cardiac arrest resuscitation is associated with evidence of small bowel mucosal damage in most patients, with a short and intense I-FABP elevation at admission and a decrease in citrulline concentration during the first day. In this study, low plasma citrulline and high I-FABP concentrations at ICU admission were predictive of a poor neurological outcome. This study confirms that cardiac arrest is a model of small bowel mucosal ischemia and suggests that enterocyte damage is a piece in the puzzle of post-cardiac arrest syndrome.
authors.affiliation: *Intensive Care Unit †Clinical Chemistry Unit, Besançon University Hospital, Besançon, France ‡Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Monash, Australia §EA 3920 and INSERM IFR 133, University of Franche Comté, Besançon, France.
authors.forename: Gaël
authors.initials: G
authors.lastname: Piton
authors.forename: Nicolas
authors.initials: N
authors.lastname: Belin
authors.forename: Loïc
authors.initials: L
authors.lastname: Barrot
authors.forename: François
authors.initials: F
authors.lastname: Belon
authors.forename: Benoit
authors.initials: B
authors.lastname: Cypriani
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Navellou
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002956:Citrulline / Q000097:blood; D020895:Enterocytes / Q000473:pathology*; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000175:diagnosis / Q000473:pathology*; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011379:Prognosis; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D002956:Citrulline