Abstract
Background Intestinal fatty acid-binding protein (I-FABP) has been shown to be of high diagnostic value in patients with acute mesenteric ischemia. Whether these results can be reproduced in critically ill patients on the ICU was to be investigated. Materials and Methods I-FABP was measured in serum and urine of 43 critically ill patients in ICU when mesenteric ischemia was suspected. Bowel ischemia was confirmed in 21 patients (group 1). 22 patients who survived at least seven days without confirmation of ischemia were assigned to group 2. I-FABP levels were compared between the groups, and interval from the event that has triggered ischemia to I-FABP measurement was recorded. Results For the identification of patients with mesenteric ischemia, sensitivity, specificity, and area under the curve (AUC) for serum and urine I-FABP were 33.3%, 95.5%, and 0.565 and 81.3%, 70.0%, and 0.694, respectively. I-FABP measurements performed within 12 to 48 h after the event that triggered ischemia showed a sensitivity, specificity, and AUC for serum and urine of 75%, 100%, and 0.853 and 100%, 73.3%, and 0.856, respectively. Conclusions In ICU patients, one single I-FABP measurement at the time of clinical suspicion failed to reliably detect or exclude mesenteric ischemia. A higher diagnostic value of I-FABP was only confirmed in the early stages of mesenteric ischemia. I-FABP may be used most appropriately in perioperative monitoring.
Highlights
Splanchnic hypoperfusion has an important impact on the treatment of critically ill patients in intensive care units, either as transient mesenteric ischemia triggering a gutderived systemic inflammatory response syndrome (SIRS) or as mesenteric ischemic necrosis [1, 2]
Since seventy percent of the mesenteric blood flow is directed to the mucosal and submucosal layers of the bowel, these layers are most susceptible to ischemia
One patient without confirmation of mesenteric ischemia died on day 5 and, could not be assigned to any of the groups
Summary
Splanchnic hypoperfusion has an important impact on the treatment of critically ill patients in intensive care units, either as transient mesenteric ischemia triggering a gutderived systemic inflammatory response syndrome (SIRS) or as mesenteric ischemic necrosis [1, 2]. It can be caused by shock situations of various etiologies, for example, major surgery, thromboembolic mesenteric artery occlusion, and burns. Intestinal fatty acid-binding protein (I-FABP) has been shown to be of high diagnostic value in patients with acute mesenteric ischemia Whether these results can be reproduced in critically ill patients on the ICU was to be investigated. I-FABP may be used most appropriately in perioperative monitoring
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