Prognostic impact of the serum heart-type fatty acid-binding protein (H-FABP) levels in patients admitted to the non-surgical intensive care unit

I-FABP, a fatty-acid-binding protein, is considered as a highly sensitive and highly specific marker of damage to the intestinal mucosa and could be used as an informative indicator of its affection in gastrointestinal insufficiency syndrome in newborns. Damage to the mucous membrane in patients requiring intensive care will always be accompanied by the basic mechanisms of critical states, ischemia and hypoxia. The aim of the work was to improve the diagnosis and assessment of the effectiveness of intensive care in newborns with gastrointestinal insufficiency syndrome by determining the I-FABP level. A prospective randomized clinical study included 20 newborns with gastrointestinal insufficiency syndrome. The concentration of blood plasma I-FABP in the examined patients was investigated, depending on the severity of the syndrome and the tactics of intensive care. It was established that the I-FABP concentration in 95% of cases was higher than the physiological value. This marker was significantly increased in newborns with clinically significant gastrointestinal insufficiency syndrome and decreased with lowering manifestations of this syndrome and under modified therapy with succinic acid and lactobacillus probiotics. Thus, an increase in the I-FABP concentration in newborns receiving an intensive care in 95% of cases points out the presence of gastrointestinal insufficiency syndrome that confirms a high sensitivity of the indicator. This marker can be used as a criterion for evaluating dynamics and stages of gastrointestinal insufficiency syndrome, accompanied by organic disorders, as well as a criterion for measuring the therapeutic efficacy for this syndrome.

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Association between enterocyte injury and fluid balance in patients with septic shock: a post hoc exploratory analysis of a prospective observational study

BMC Anesthesiology ◽

10.1186/s12871-021-01515-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Haruka Yokoyama ◽

Motohiro Sekino ◽

Hiroyuki Funaoka ◽

Shuntaro Sato ◽

Hiroshi Araki ◽

...

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Intensive Care ◽

Fatty Acid ◽

Confidence Interval ◽

Intensive Care Unit Admission ◽

Fluid Balance ◽

Fatty Acid Binding Protein ◽

Fatty Acid Binding ◽

Acid Binding Protein

Abstract Background The required fluid volume differs among patients with septic shock. Enterocyte injury caused by shock may increase the need for fluid by triggering a systematic inflammatory response or an ischemia-reperfusion injury in the presence of intestinal ischemia/necrosis. This study aimed to evaluate the association between enterocyte injury and positive fluid balance in patients with septic shock. Methods This study was a post hoc exploratory analysis of a prospective observational study that assessed the association between serum intestinal fatty acid-binding protein, a biomarker of enterocyte injury, and mortality in patients with septic shock. Intestinal fatty acid-binding protein levels were recorded on intensive care unit admission, and fluid balance was monitored from intensive care unit admission to Day 7. The association between intestinal fatty acid-binding protein levels at admission and the infusion balance during the early period after intensive care unit admission was evaluated. Multiple linear regression analysis, with adjustments for severity score and renal function, was performed. Results Overall, data of 57 patients were analyzed. Logarithmically transformed intestinal fatty acid-binding protein levels were significantly associated with cumulative fluid balance per body weight at 24 and 72 h post-intensive care unit admission both before (Pearson’s r = 0.490 [95% confidence interval: 0.263–0.666]; P < 0.001 and r = 0.479 [95% confidence interval: 0.240–0.664]; P < 0.001, respectively) and after (estimate, 14.4 [95% confidence interval: 4.1–24.7]; P = 0.007 and estimate, 26.9 [95% confidence interval: 11.0–42.7]; P = 0.001, respectively) adjusting for severity score and renal function. Conclusions Enterocyte injury was significantly associated with cumulative fluid balance at 24 and 72 h post-intensive care unit admission. Enterocyte injury in patients with septic shock may be related to excessive fluid accumulation during the early period after intensive care unit admission.

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