Intestinal fatty acid binding protein as a predictor for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; a prospective cohort study (I-Fabulous study)

Strang, S.G.; Habes, Quirine L.M.; Hoven, B. van der; Tuinebreijer, W.E.; Verhofstad, Michael H.J.; Pickkers, Peter; Lieshout, Esther M.M. Van; Waes, Oscar J.F. Van

doi:10.1016/j.jcrc.2020.08.023

Cited by 6 publications

(7 citation statements)

References 29 publications

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“…In contrast to the abovementioned study by Strang et al [ 9 ], our study demonstrated a statistically significant positive correlation between the plasma I-FABP levels and the IAP values in children with appendicular peritonitis. We did not determine the urine I-FABP.…”

Section: Discussioncontrasting

confidence: 99%

“…There are limited data in the literature about correlation between the plasma I-FABP and IAP levels. In the prospective observational study by Strang et al [ 9 ], among 198 severely ill adults, including 60% of subjects with IAH and 8% with ACS, the level of I-FABP in urine was positively correlated with the level of IAP. But the authors did not find the correlation between the serum I-FABP and the IAP.…”

Section: Discussionmentioning

confidence: 99%

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The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis

Перова-Шаронова

Фесенко

2021

Critical Care Research and Practice

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Introduction. Peritonitis is one of the risk factors for the development of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). The plasma citrulline and intestinal fatty acid-binding protein (I-FABP) are informative markers of intestinal barrier function. The aim of this study was to determine the correlation of the plasma citrulline and I-FABP with intra-abdominal pressure (IAP) and their relation to analgesia techniques in children suffering from appendicular peritonitis. Materials and Methods. 74 children operated for appendicular peritonitis were randomized into three groups of postoperative analgesia: “Opioids” (n = 25), intravenous morphine of 10 mcg/kg/h; “Lidocaine” (n = 23), intravenous lidocaine with initial bolus of 1.5 mg/kg and then infusion of 1.5 mg/kg/h; and “EA” (n = 26), epidurally 0.25% bupivacaine with initial bolus of 1 mg/kg and then infusion of 0.4 mg/kg/year. Retrospectively patients in each group were divided into the following subgroups: “without IAH” (n = 33), “IAH” (n = 27), and “ACS” (n = 14). We detected citrulline and I-FABP in plasma on day 1 (D1) and day 3 (D3) of hospital stay. Results. The patients without IAH on D1 presented significantly higher plasma citrulline (23.7 (16.0–31.3) nmol/ml) and lower I-FABP (76.9 (32.6–121.1) pg/ml) levels compared with patients in subgroup “IAH” (9.3 (7.3–11.3) nmol/ml and 226.0 (161.8–290.3) pg/ml, respectively) and subgroup “ACS” (6.9 (5.3–8.6) nmol/ml and 1011.7 (731.9–1291.5) pg/ml, respectively). The IAP had strong inverse correlation (rs = −0.74; p < 0.00001 ) with citrulline and positive strong correlation (rs = 0.73; p < 0.00001 ) with I-FABP. The citrulline in patients with IAH during three days postoperatively increased significantly in “Lidocaine” to 72% ( p = 0.01 ) and in “EA” to 138% ( p = 0.02 ), but it decreased to 13% ( p = 0.37 ) in “Opioids” group. In children with ACS, citrulline on D3 was significantly higher than that on D1 and increased in “Lidocaine” to 59% ( p = 0.05 ) and in “EA” to 134% ( p = 0.001 ), but in “Opioids” it decreased to 30% ( p = 0.48 ). The I-FABP in patients with IAH decreased to 12% in “Lidocaine” group ( p = 0.86 ) and to 75% in “EA” group ( p = 0.01 ), but it increased to 37% ( p = 0.57 ) in “Opioids” group. During observation period, I-FABP in patients with ACS decreased significantly in “Lidocaine” to 42% ( p = 0.05 ) and in “EA” to 96% ( p = 0.003 ), but it increased in “Opioids” to 63% ( p = 0.22 ). Conclusions. The IAP was inversely correlated with plasma citrulline and positively correlated with I-FABP in children with appendicular peritonitis. Epidural analgesia is the most protective for intestinal wall barrier function in patients at risk of IAH and ACS.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis

Перова-Шаронова

Фесенко

2021

Critical Care Research and Practice

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“…However, the inverse correlation between IAP and I-FABP is contradictory with the expected outcome, as reduced intestinal blood flow resulting from increased IAP is expected to cause mucosal ischemia which proved to be related to increased levels of I-FABP [23][24][25][26]. This was confirmed by recently published outcomes of the I-Fabulous study [15]. That study demonstrated a positive correlation between IAP and I-FABP among 198 ICU patients with two or more risk factors for IAH.…”

Section: Discussionmentioning

confidence: 82%

“…Clinical baseline characteristics of 58 included patients are shown in Table 1. Patients had a median age of 48 years (30-58 years), a median APACHE II score of 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17) and a median burned TBSA of 29% (P 25 -P 75 19-42%, deep dermal and full thickness). Thirty-six (62%) patients were male, 51 (88%) patients had a flame burn, 31(53%) patients developed IAH and 17 (29%) patients developed new organ failure.…”

Section: Resultsmentioning

confidence: 99%

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Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study)

Strang

Breederveld

Cleffken

et al. 2021

Eur J Trauma Emerg Surg

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Purpose Severely burned patients are at risk for intra-abdominal hypertension (IAH) and associated complications such as organ failure, abdominal compartment syndrome (ACS), and death. The aim of this study was to determine the prevalence of IAH among severely burned patients. The secondary aim was to determine the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications. Methods A prospective observational study was performed in two burn centers in the Netherlands. Fifty-eight patients with burn injuries ≥ 15% of total body surface area (TBSA) were included. Intra-abdominal pressure (IAP) and urinary I-FABP, measured every 6 h during 72 h. Prevalence of IAH, new organ failure and ACS, and the value of urinary intestinal fatty acid binding protein (I-FABP) as early marker for IAH-associated complications were determined. Results Thirty-one (53%) patients developed IAH, 17 (29%) patients developed new organ failure, but no patients developed ACS. Patients had burns of 29% (P25–P75 19–42%) TBSA. Ln-transformed levels of urinary I-FABP and IAP were inversely correlated with an estimate of − 0.06 (95% CI − 0.10 to − 0.02; p = 0.002). Maximal urinary I-FABP levels had a fair discriminatory ability for patients with IAH with an area under the ROC curve of 74% (p = 0.001). Urinary I-FABP levels had no predictive value for IAH or new organ failure in severe burn patients. Conclusions The prevalence of IAH among patients with ≥ 15% TBSA burned was 53%. None of the patients developed ACS. A relevant diagnostic or predictive value of I-FABP levels in identifying patients at risk for IAH-related complications, could not be demonstrated. Level of evidence Level III, epidemiologic and diagnostic prospective observational study.

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Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis

Jena

Singh

Kochhar

2023

Indian J Gastroenterol

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Intestinal fatty acid binding protein as a predictor for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; a prospective cohort study (I-Fabulous study)

Cited by 6 publications

References 29 publications

The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis

The Intestinal Barrier Function and Intra-Abdominal Pressure Depend on Postoperative Analgesia Technique in Children with Appendicular Peritonitis

Prevalence of intra-abdominal hypertension and markers for associated complications among severe burn patients: a multicenter prospective cohort study (BURNIAH study)

Intra-abdominal hypertension and abdominal compartment syndrome in acute pancreatitis

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