Enterocyte Damage

Abstract

Cardiac arrest is considered to be a cause of small bowel ischemia, but the consequences of cardiac arrest on the human small bowel have been rarely studied. Plasma citrulline concentration is a marker of functional enterocyte mass, and plasma intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to measure enterocyte biomarkers after cardiac arrest and to study the prognostic value of biomarker abnormalities. This is a prospective, observational, single-center study of patients admitted to the intensive care unit (ICU) for cardiac arrest, evaluating plasma citrulline and I-FABP concentrations at admission and after 24 h and variables according to the Utstein criteria. Variables according to 28-day Cerebral Performance Category score of 1 to 2 (good neurological outcome) versus 3 to 5 (poor neurological outcome) were compared. Sixty-nine patients with cardiac arrest of both cardiac and hypoxic origin were included. At ICU admission, plasma citrulline concentration was low in 65% and plasma I-FABP was elevated in 82% of the patients. After 24 h, plasma citrulline was low in 82% and I-FABP was normal in 60% of the patients. Patients with a poor neurological outcome had a lower plasma citrulline concentration and a higher I-FABP concentration at ICU admission. By multivariate analysis, plasma citrulline levels of 13.1 μmol L or less and I-FABP more than 260 pg mL were independently associated with a poor neurological outcome (odds ratio, 21.9 [2.2-215], and odds ratio, 13.6 [1.4-129], respectively). Cardiac arrest resuscitation is associated with evidence of small bowel mucosal damage in most patients, with a short and intense I-FABP elevation at admission and a decrease in citrulline concentration during the first day. In this study, low plasma citrulline and high I-FABP concentrations at ICU admission were predictive of a poor neurological outcome. This study confirms that cardiac arrest is a model of small bowel mucosal ischemia and suggests that enterocyte damage is a piece in the puzzle of post-cardiac arrest syndrome.

Diagnostic accuracy of novel serological biomarkers to detect acute mesenteric ischemia: a systematic review and meta-analysis

“…These results should be interpreted with caution, since there was a high pre-test probability. Nevertheless, citrulline remains a potential accurate marker for AMI, since it has been shown to be a reliable marker of functional enterocyte mass [ 24 ], prognostic value of mortality in the ICU [ 60 ], and NOMI after cardiac arrest [ 61 ].…”

Post-resuscitation shock: recent advances in pathophysiology and treatment

“…Some human and prospective studies have suggested that gut injury could also contribute to the vasoplegia observed in the post-resuscitation shock through its ability to provoke or worsen a systemic inflammatory response [ 27 – 29 ]. Indeed, in post-CA patients, markers of intestinal injury are increased and endotoxemia is frequent [ 27 , 28 ], this latter being associated with the severity of vasoplegia [ 29 ]. However, its incidence is still unknown and the relationship between post-resuscitation shock and gut injury is complex, as the two are closely intertwined.…”

Gastric ultrasound, citrulline, and intestinal fatty acid–binding protein as markers of gastrointestinal dysfunction in critically ill patients: A pilot prospective cohort study

“…30,31 A few studies indicated presence of low serum citrulline concentrations in critically ill patients. [32][33][34] Plasma citrulline concentrations <20 µmol/L were noted in 50%-68% of patients at ICU admission. [33][34][35] A plasma citrulline concentration of <20 µmol/L has been shown to be indicative of a decrease in enterocyte mass.…”