Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients

Abstract Aims Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to expl...

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Bibliographic Details
Published in:Resuscitation 2013-01, Vol.84 (1), p.60-65
Main Authors: Grimaldi, D, Guivarch, E, Neveux, N, Fichet, J, Pène, F, Marx, J.-S, Chiche, J.-D, Cynober, L, Mira, J.-P, Cariou, A
Format: Article
Language:English
Subjects:
Biomarkers - metabolism
Cardiac arrest
Cardiopulmonary Resuscitation
Chromatography, High Pressure Liquid
Citrulline
Citrulline - blood
Emergency
Endotoxemia - blood
Endotoxemia - physiopathology
Endotoxin
Endotoxins - blood
Enzyme-Linked Immunosorbent Assay
Fatty Acid-Binding Proteins - urine
Female
Gut injury
Humans
IFABP
Intestines - metabolism
Intestines - physiopathology
Luminescence
Male
Middle Aged
Out-of-Hospital Cardiac Arrest - metabolism
Out-of-Hospital Cardiac Arrest - therapy
Prospective Studies
Statistics, Nonparametric
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Summary:Abstract Aims Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to explore intestinal failure biomarkers in post-cardiac arrest patients and to correlate them with endotoxemia. 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, days 1–3 and 6. We explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values. Results IFABP was extremely high at admission and normalized at D3 (6668 pg/mL vs 39 pg/mL, p = 0.01). Lowest median of citrulline ( N = 20–40 μmol/L) was attained at D2 (11 μmol/L at D2 vs 24 μmol/L at admission, p = 0.01) and tended to normalize at D6 (21 μmol/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 EU vs −0.19 EU, p = 0.03). Highest endotoxin level was positively correlated with D3 SOFA score ( R2 = 0.45, p = 0.004). Conclusion Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post-resuscitation shock and organ failure.
ISSN:0300-9572
1873-1570
DOI:10.1016/j.resuscitation.2012.06.010