Abstract
IntroductionLoss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma. Thus far, clinical data concerning the occurrence and significance of intestinal damage after trauma remain scarce. This study investigates whether early intestinal epithelial cell damage occurs in trauma patients and, if present, whether such cell injury is related to shock, injury severity and the subsequent inflammatory response.MethodsProspective observational cohort study in 96 adult trauma patients. Upon arrival at the emergency room (ER) plasma levels of intestinal fatty acid binding protein (i-FABP), a specific marker for damage of differentiated enterocytes, were measured. Factors that potentially influence the development of intestinal cell damage after trauma were determined, including the presence of shock and the extent of abdominal trauma and general injury severity. Furthermore, early plasma levels of i-FABP were related to inflammatory markers interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP).ResultsUpon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01). The elevation of i-FABP was related to the extent of abdominal trauma as well as general injury severity (P < 0.05). Circulatory i-FABP concentrations at ER correlated positively with IL-6 and PCT levels at the first day (r2 = 0.19; P < 0.01 and r2 = 0.36; P < 0.001 respectively) and CRP concentrations at the second day after trauma (r2 = 0.25; P < 0.01).ConclusionsThis study reveals early presence of intestinal epithelial cell damage in trauma patients. The extent of intestinal damage is associated with the presence of shock and injury severity. Early intestinal damage precedes and is related to the subsequent developing inflammatory response.
Highlights
Loss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma
The extent of intestinal damage is associated with the presence of shock and injury severity
Concentrations of intestinal fatty acid binding protein (i-FABP) in trauma patients were significantly increased in comparison with healthy controls (303 (41 to 84,846) pg/mL vs. 87 (41 to 413) pg/mL; P < 0.001; Figure 1). i-FABP levels at emergency room (ER) were elevated compared with levels at day 1 (174 (41 to 1805) pg/mL; P < 0.001) and day 2 (103 (41 to 1049) pg/mL; P < 0.001)
Summary
Loss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma. Severe trauma and major surgery frequently result in the development of inflammatory complications, including systemic inflammatory response syndrome, sepsis, and organ failure. These conditions are associated with a poor clinical prognosis [1,2]. Enterocyte damage following shock was paralleled by disruption of tight junction complexes and subsequent failure of the gut barrier. This resulted in translocation of luminal bacteria and toxins into the gut wall, which has been associated with the development of the inflammatory response [8,9,10,11,12]. Intracellular proteins that are released by damaged cells may contribute to the unfolding systemic inflammatory response by acting as damage-associated molecular patterns [13,14,15]
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