Measurements of I-FABP and citrulline in the postoperative period of non-cardiac surgeries with gastrointestinal complications: A prospective cohort observational study

• Published in: Journal of critical care Vol. 81; p. 154530
• Main Authors: Ajeje, Eduarda Tebet, Gandolfi, Joelma Villafanha, Cavallari, Vinicius, Silva-Jr, João Manoel, de Freitas Chaves, Renato Carneiro, Berger-Estilita, Joana, Lobo, Suzana Margareth
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2024; Elsevier Limited
• Subjects: Abdomen; Acute gastrointestinal injury; Auscultation; Biomarkers; Biomarkers - urine; Blood; Citrulline; Citrulline - urine; Diarrhea; Fatty Acid-Binding Proteins - urine; Fatty acids; Gastrointestinal; Heart surgery; Humans; Hypertension; I-FABP; Intensive care; Medical diagnosis; Medical prognosis; Mortality; Patients; Postoperative Complications - urine; Postoperative Period; Prospective Studies; Sepsis; Urine; Variance analysis; United States > US; Biomarkers; I-FABP; Acute gastrointestinal injury; Citrulline; Gastrointestinal
• DOI: 10.1016/j.jcrc.2024.154530
• EISSN: 1557-8615
• ISSN: 0883-9441; 1557-8615

Acute Gastrointestinal Injury (AGI) is associated with adverse clinical outcomes, including increased mortality. We aimed to investigate the potential of citrulline and intestinal fatty acid binding protein (I-FABP) as biomarkers for early AGI diagnosis and predicting outcomes in surgical patients.
Prospective cohort study involving patients who underwent non-cardiac surgeries and were admitted to Intensive Care Units. AGI diagnosis was based on specific criteria, and severity was categorised following established guidelines. Statistical analyses were performed to assess the diagnostic accuracy of the biomarkers and their association with outcomes, P significant when <0.05.
AGI was identified in 40.3% of patients with varying severity. Mortality rates were significantly higher in the AGI group in the ICU (19.4% vs. 0%, p = 0.001) and hospital (22.6% vs. 2.17%, p = 0.003). Urinary I-FABP levels on days 3 and 7 showed reasonable and good accuracy for AGI diagnosis (AUC 0.732 and 0.813, respectively). Urinary I-FABP levels on days 2 and 3 accurately predict sepsis. Urinary citrulline levels on day one predicted mortality (AUC 0.87) furthermore urinary I-FABP levels on day 2 showed reasonable accuracy (sensitivity 83.3%, specificity 92.4%).
Urinary I-FABP and citrulline levels are promising diagnostic and prognostic markers in ICU patients following non-cardiac surgeries.
•Acute gastrointestinal injury was very frequent after non-cardiac surgeries.•Accuracy of biomarkers citrulline and IFAP were tested for AGI, sepsis and death.•Urinary I-FABP exhibits a high diagnostic accuracy for detecting AGI and sepsis.•Urinary citrulline and I-FABP levels were reliable predictors of mortality.