Non-Invasive Markers for Early Diagnosis and Determination of the Severity of Necrotizing Enterocolitis

• Published in: Annals of surgery Vol. 251; no. 6; pp. 1174 - 1180
• Main Authors: THUIJLS, Geertje, DERIKX, Joep P. M, KRAMER, Boris W, BUURMAN, Wim A, HEINEMAN, Erik, VAN WIJCK, Kim, ZIMMERMANN, Luc J. I, DEGRAEUWE, Pieter L, MULDER, Twan L, VAN DER ZEE, David C, BROUWERS, Hens A. A, VERHOEVEN, Bas H, VAN HEURN, L. W. Ernest
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-06-2010
• Subjects: Biological and medical sciences; Biomarkers - analysis; Claudin-3; Enterocolitis, Necrotizing - diagnosis; Enterocolitis, Necrotizing - pathology; Fatty Acid-Binding Proteins - urine; Feces - chemistry; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Humans; Infant, Newborn; Leukocyte L1 Antigen Complex - analysis; Medical sciences; Membrane Proteins - urine; Other diseases. Semiology; Severity of Illness Index; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Human; Biological marker; Necrotizing enterocolitis; Biological indicator; Early stage; Medicine; Newborn; Treatment; Surgery; Non invasive method; Digestive diseases; Intestinal disease; Diagnosis
• ISSN: 0003-4932; 1528-1140
• DOI: 10.1097/SLA.0b013e3181d778c4

To improve diagnosis of necrotizing enterocolitis (NEC) by noninvasive markers representing gut wall integrity loss (I-FABP and claudin-3) and gut wall inflammation (calprotectin). Furthermore, the usefulness of I-FABP to predict NEC severity and to screen for NEC was evaluated.
Urinary I-FABP and claudin-3 concentrations and fecal calprotectin concentrations were measured in 35 consecutive neonates suspected of NEC at the moment of NEC suspicion. To investigate I-FABP as screening tool for NEC, daily urinary levels were determined in 6 neonates who developed NEC out of 226 neonates included before clinical suspicion of NEC.
Of 35 neonates suspected of NEC, 14 developed NEC. Median I-FABP, claudin-3, and calprotectin levels were significantly higher in neonates with NEC than in neonates with other diagnoses. Cutoff values for I-FABP (2.20 pg/nmol creatinine), claudin-3 (800.8 INT), and calprotectin (286.2 microg/g feces) showed clinically relevant positive likelihood ratios (LRs) of 9.30, 3.74, 12.29, and negative LRs of 0.08, 0.36, 0.15, respectively. At suspicion of NEC, median urinary I-FABP levels of neonates with intestinal necrosis necessitating surgery or causing death were significantly higher than urinary I-FABP levels in conservatively treated neonates. Of the 226 neonates included before clinical suspicion of NEC, 6 developed NEC. In 4 of these 6 neonates I-FABP levels were not above the cutoff level to diagnose NEC before clinical suspicion.
Urinary I-FABP levels are not suitable as screening tool for NEC before clinical suspicion. However, urinary I-FABP and claudin-3 and fecal calprotectin are promising diagnostic markers for NEC. Furthermore, urinary I-FABP might also be used to predict disease severity.