Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

Abstract

A delay in diagnosing hollow viscus injury (HVI) causes an increase in mortality and morbidity. HVI remains a challenge to diagnose, and there is no specific diagnostic biomarker for HVI. We evaluated the utility of intestinal fatty acid–binding protein (I-FABP) in diagnosing HVI in blunt trauma patients. Within a 5-year period, 93 consecutive patients with clinically suspected HVI at our trauma center were prospectively enrolled. The diagnostic performance of I-FABP for HVI was compared with that of other various parameters (physical, laboratory, and radiographic findings). HVI was diagnosed in 13 patients (14%), and non-HVI was diagnosed in 80 patients (86%). The level of I-FABP was significantly higher in patients with HVI than in those with non-HVI (P = 0.014; area under the curve, 0.71). The sensitivity, specificity, positive predictive value, and negative predictive value were 76.9%, 70.0%, 29.4%, and 94.9%, respectively (P = 0.003). However, all other biomarkers were not significantly different between the groups. Presence of extraluminal air, bowel wall thickening on computed tomography (CT), and peritonitis signs were significantly higher in patients with HVI (P < 0.05). Of 49 patients (52.7%) who had a negative I-FABP and negative peritonitis signs, none developed HVI (sensitivity, 100%; negative predictive value, 100%). This is the first study that demonstrated the diagnostic value of a biomarker for HVI. I-FABP has a higher negative predictive value compared to traditional diagnostic tests. Although the accuracy of I-FABP alone was insufficient, the combination of I-FABP and other findings can enhance diagnostic ability.

Accuracy of CT Scan for Detecting Hollow Viscus Injury in Penetrating Abdominal Trauma

“…Only abdominal tenderness and an elevated I-FABP level were statistically significant. Several other studies showed similar results, confirming that clinical examination together with a CT scan of the abdomen plays a vital role in the early diagnosis of an HVI [23][24][25][26]. In keeping with these studies, none of the clinical features, location of injuries, or metabolic parameters we evaluated were statistically significant.…”

Intestinal fatty acid-binding protein, a biomarker of intestinal barrier dysfunction, increases with the progression of type 2 diabetes

“…I-FABP is an intracellular protein specifically and abundantly expressed in intestinal epithelial cells, and its increased serum concentration represents intestinal epithelial cell damage and IB dysfunction ( Gajda & Storch, 2015 ; Wells et al, 2017 ). As a biomarker of IB dysfunction, I-FABP determination has been used in patients with necrotizing enterocolitis ( Coufal et al, 2020 ), acute mesenteric ischemia ( Salim et al, 2017 ), strangulated small bowel obstruction ( Kittaka et al, 2014 ), Crohn’s disease ( Sarikaya et al, 2015 ), blunt trauma ( Matsumoto et al, 2017 ), celiac disease ( Oldenburger et al, 2018 ), acute pancreatitis( Kupcinskas et al, 2018 ; Goswami et al, 2017 ), acute decompensated heart failure ( Kitai et al, 2017 ), chronic renal failure ( Okada et al, 2018 ), septic shock ( Sekino et al, 2017 ), psoriasis ( Sikora et al, 2019 ), and even physiological stressor-induced intestinal damage ( March et al, 2017 ). In addition to serum I-FABP, many other biomarkers are used to measure IB function ( Wells et al, 2017 ; Piton & Capellier, 2016 ).…”

Hollow viscus injury due to blunt abdominal trauma: a tertiary trauma center experience

“…Although some new peptide markers have been proposed for this purpose and found promising, their reliability has yet to be scientifically proven. [18] The jejunum and ileum were found to be the most injured organs, followed by colorectal injuries, either in combination with small bowel injuries or in isolated form. This finding is consistent with the literature.…”

“…Although some new peptide markers have been proposed for this purpose and found promising, their reliability has yet to be scientifically proven. [ 18 ]…”