Abstract
BackgroundHemorrhagic shock can lead to intestinal damage with subsequent hyperinflammation and multiple organ dysfunction syndrome (MODS). The intestinal fatty acid-binding protein (I-FABP) is solely expressed in the intestine and is released extracellulary after tissue damage. This study evaluates the validity of I-FABP as an early biomarker to detect hemorrhagic shock and abdominal injury.Patients and methodsSeverely injured patients with an Injury Severity Score (ISS) ≥ 16 points and an age ≥ 18 years, admitted from January 2010 to December 2016, were included. Overall, 26 patients retrospectively presented with hemorrhagic shock to the emergency room (ER): 8 patients without abdominal injury (“HS noAbd”) and 18 patients with abdominal injury (“HS Abd”). Furthermore, 16 severely injured patients without hemorrhagic shock and without abdominal injury (“noHS noAbd”) were retrospectively selected as controls. Plasma I-FABP levels were measured at admission to the ER and up to 3 days posttraumatic (d1-d3).ResultsMedian I-FABP levels were significantly higher in the “HS Abd” group compared with the “HS noAbd” group (28,637.0 pg/ml [IQR = 6372.4–55,550.0] vs. 7292.3 pg/ml [IQR = 1282.5–11,159.5], p < 0.05). Furthermore, I-FABP levels of both hemorrhagic shock groups were significantly higher compared with the “noHS noAbd” group (844.4 pg/ml [IQR = 530.0–1432.9], p < 0.05). The time course of I-FABP levels showed a peak on the day of admission with a subsequent decline in the post-traumatic course. Furthermore, significant correlations between I-FABP levels and clinical parameters of hemorrhagic shock, such as hemoglobin, lactate value, systolic blood pressure (SBP), and shock index, were found.The optimal cut-off level of I-FABP for detection of hemorrhagic shock was 1761.9 pg/ml with a sensitivity of 85% and a specificity of 81%.ConclusionThis study confirmed our previous observation that I-FABP might be used as a suitable early biomarker for the detection of abdominal injuries in general. In addition, I-FABP may also be a useful and a promising parameter in the diagnosis of hemorrhagic shock, because of reflecting low intestinal perfusion.
Highlights
In severely injured trauma patients, traumatic brain injury and uncontrolled bleeding remain the main causes for early mortality within the first 24 h after trauma [1].Hemorrhagic shock results in a circulatory dysfunction causing decreased tissue oxygenation and an accumulation of oxygen debt [2].In experimental models, tissue hypoperfusion has extensively been reported as a crucial pathophysiological event leading to tissue hypoxia and thereby organ failure [3, 4]
This study confirmed our previous observation that intestinal fatty acid-binding protein (I-FABP) might be used as a suitable early biomarker for the detection of abdominal injuries in general
As per definition, the AIS abdomen score was significantly higher in the “HS Patients with hemorrhagic shock and abdominal injury (Abd)” group compared with both other patient groups (p < 0.05)
Summary
In severely injured trauma patients, traumatic brain injury and uncontrolled bleeding remain the main causes for early mortality within the first 24 h after trauma [1].Hemorrhagic shock results in a circulatory dysfunction causing decreased tissue oxygenation and an accumulation of oxygen debt [2].In experimental models, tissue hypoperfusion has extensively been reported as a crucial pathophysiological event leading to tissue hypoxia and thereby organ failure [3, 4]. Hemorrhagic shock leads to a decrease of the fraction of perfused intestinal villi and thereby to an increase of the risk of villous ischemia [5] Thereby it leads to intestinal damage with disruption of tight junction complexes and subsequent failure of the gut barrier [6,7,8]. This resulted in a translocation of luminal bacteria and leads to hyperinflammatory response and secondary complications like systemic inflammatory distress syndrome (SIRS), sepsis and multi-organ dysfunction syndrome (MODS) [9,10,11,12,13], which are main causes for late mortality of severely traumatized patients [14, 15]. This study evaluates the validity of I-FABP as an early biomarker to detect hemorrhagic shock and abdominal injury
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