title: Acute intestinal damage following severe burn correlates with the development of multiple organ dysfunction syndrome: A prospective cohort study.
abstract: BACKGROUND
  Severely burned patients occasionally suffer intestinal ischemia leading to a fatal outcome, and the gut is considered a "motor" driving the development of multiple organ failure. However, in clinical settings, it has been difficult to assess acute intestinal damage following burn and its consequence to patient outcome. Intestinal fatty acid binding protein (I-FABP) is a known biomarker for diagnosing intestinal ischemia/damage. This study aimed to assess the extent of intestinal damage using serial I-FABP measurements following severe burn and to clarify the association between intestinal damage and the development of organ dysfunctions.
  
  
  METHODS
  Patients aged >15years old who suffered burn over 20% total body surface area (TBSA) were enrolled in this prospective cohort study. Patients with cardiac arrest on admission or who were transferred >24h after injury were excluded. Patients with chemical burn were also excluded. Burn size and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were recorded at the time of patient enrollment. I-FABP was measured on admission and at 1, 4, 7, 14, and 30days following injury. Other biomarkers such as lactate, lactate dehydrogenase (LDH), creatine kinase (CK), aspartate aminotransferase (AST), alanine aminotransferase, amylase, and creatinine (Cre) were also measured at the same time points as I-FABP. We also evaluated the serial change in Sequential Organ Failure Assessment (SOFA) score.
  
  
  RESULTS
  The study included 32 patients. Serum I-FABP level on the day of admission was significantly increased in the patients compared with healthy controls. Increased I-FABP levels were normalized at 4days after injury. The serum level of I-FABP on the day of admission correlated with %TBSA (III) and APACHE II score. A high I-FABP level on admission was associated with the subsequent development of multiple organ dysfunction. The increase in I-FABP level also correlated with increases of AST, LDH, and CK levels.
  
  
  CONCLUSIONS
  Serum level of I-FABP on admission day does not correlate with burn size, but with the deep burn area. The gut might be a crucial target organ following severe burn, and gut damage could have an important role in the development of multiple organ dysfunction.
authors.affiliation: Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan; Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan. Electronic address: ao1219@gmail.com.
authors.forename: Akinori
authors.initials: A
authors.lastname: Osuka
authors.affiliation: Department of Clinical Laboratory, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Kusuki
authors.affiliation: Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Matsuura
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shimizu
authors.affiliation: Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Suita, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogura
authors.affiliation: Department of Trauma, Critical Care Medicine and Burn Center, Japan Community Healthcare Organization Chukyo Hospital, Nagoya, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Ueyama
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000410:Alanine Transaminase / Q000097:blood; D000681:Amylases / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D001830:Body Surface Area; D002056:Burns / Q000097:blood / Q000453:epidemiology*; D016022:Case-Control Studies; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D050556:Fatty Acid-Binding Proteins / Q000097:blood; D005260:Female; D006801:Humans; D007410:Intestinal Diseases / Q000097:blood / Q000453:epidemiology*; D007422:Intestines / Q000098:blood supply; D007511:Ischemia / Q000097:blood / Q000453:epidemiology*; D007770:L-Lactate Dehydrogenase / Q000097:blood; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000453:epidemiology*; D011446:Prospective Studies; D015599:Trauma Severity Indices
chemical_list: D015415:Biomarkers; D050556:Fatty Acid-Binding Proteins; D019344:Lactic Acid; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase; D000681:Amylases
keywords: Burn; Intestinal damage; Organ dysfunction