Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients
Grimaldi D et al. – Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post–resuscitation shock and organ failure.Methods
- Following resuscitation after cardiac arrest, 21 patients were prospectively studied.
- Urinary intestinal fatty acid–binding protein (IFABP), which marks intestinal permeability, plasma citrulline, which reflects the functional enterocyte mass, and whole blood endotoxin were measured at admission, Day 1, 2, 3 and 6.
- The authors explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values.
- IFABP was extremely high at admission and normalized at D3 (6668pg/mL vs 39pg/mL p=0.01).
- Lowest median of citrulline (N 20–40µmol/L) was attained at D2 (11µmol/L at D2 vs 24µmol/L at admission p=0.01) and tended to normalize at D6 (21µmol/L).
- During ICU stay, 86% of patients presented a detectable endotoxemia.
- Highest endotoxin level was positively correlated with highest IFABP level (R2=0.31, p=0.01) and was inversely correlated with lowest plasma citrulline levels (R2=0.55, p<0.001).
- Endotoxin levels increased between admission and D2 in patients with post–resuscitation shock, whereas it decreases in patients with no shock (median+0.33 vs –0.19EU, p=0.03).
- Highest endotoxin level was positively correlated with D3 SOFA score (R2=0.45, p=0.004).