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Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study.

de Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve JW, Marzi I, Buurman WA - Crit Care (2009)

Bottom Line: Upon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01).The extent of intestinal damage is associated with the presence of shock and injury severity.Early intestinal damage precedes and is related to the subsequent developing inflammatory response.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, 6229 ER, Maastricht, The Netherlands. jj.dehaan@ah.unimaas.nl

ABSTRACT

Introduction: Loss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma. Thus far, clinical data concerning the occurrence and significance of intestinal damage after trauma remain scarce. This study investigates whether early intestinal epithelial cell damage occurs in trauma patients and, if present, whether such cell injury is related to shock, injury severity and the subsequent inflammatory response.

Methods: Prospective observational cohort study in 96 adult trauma patients. Upon arrival at the emergency room (ER) plasma levels of intestinal fatty acid binding protein (i-FABP), a specific marker for damage of differentiated enterocytes, were measured. Factors that potentially influence the development of intestinal cell damage after trauma were determined, including the presence of shock and the extent of abdominal trauma and general injury severity. Furthermore, early plasma levels of i-FABP were related to inflammatory markers interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP).

Results: Upon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01). The elevation of i-FABP was related to the extent of abdominal trauma as well as general injury severity (P < 0.05). Circulatory i-FABP concentrations at ER correlated positively with IL-6 and PCT levels at the first day (r2 = 0.19; P < 0.01 and r2 = 0.36; P < 0.001 respectively) and CRP concentrations at the second day after trauma (r2 = 0.25; P < 0.01).

Conclusions: This study reveals early presence of intestinal epithelial cell damage in trauma patients. The extent of intestinal damage is associated with the presence of shock and injury severity. Early intestinal damage precedes and is related to the subsequent developing inflammatory response.

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Intestinal mucosal cell damage after trauma correlates positively with the inflammatory response. (a) Peak concentrations of circulating IL-6 and procalcitonin (PCT) were reached at the first day after trauma, whereas highest levels of C-reactive protein (CRP) were measured at the second day (all parameters: * P < 0.05 vs. emergency room (ER); † P < 0.001 vs. day 1). (b to d) i-FABP concentrations at ER correlated positively with peak concentrations of IL-6 (r2 = 0.19, P < 0.01), PCT (r2 = 0.36, P < 0.001), and CRP (r2 = 0.25, P < 0.01). All data are shown in natural logarithmic scale.
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Figure 4: Intestinal mucosal cell damage after trauma correlates positively with the inflammatory response. (a) Peak concentrations of circulating IL-6 and procalcitonin (PCT) were reached at the first day after trauma, whereas highest levels of C-reactive protein (CRP) were measured at the second day (all parameters: * P < 0.05 vs. emergency room (ER); † P < 0.001 vs. day 1). (b to d) i-FABP concentrations at ER correlated positively with peak concentrations of IL-6 (r2 = 0.19, P < 0.01), PCT (r2 = 0.36, P < 0.001), and CRP (r2 = 0.25, P < 0.01). All data are shown in natural logarithmic scale.

Mentions: Circulating levels of IL-6, PCT, and CRP were measured on arrival at the ER and at the following days to explore the inflammatory response following trauma. Plasma IL-6 strongly increased at the first day (0.11 (0.01 to 18.35) ng/mL vs. ER: 0.04 (0.00 to 5.16) ng/mL, P < 0.05) and remained elevated at the second day (0.12 (0.00 to 11.37) ng/mL). Levels of PCT were barely detectable on presentation (0.06 (0.02 to 1.06) ng/mL), whereas elevated levels were measured at day 1 and 2 (0.22 (0.04 to 18.23) ng/mL and 0.22 (0.03 to 18.55) ng/mL, each P < 0.001 to ER). Consecutive measurements of acute phase protein CRP showed highest plasma values on the second day post-trauma (1.21 (0.06 to 2.72) mg/mL) compared with the first day (0.42 (0.05 to 1.57) mg/mL, P < 0.001) and to CRP concentrations on admittance (0.01 (0.00 to 0.28) mg/mL, P < 0.001; Figure 4a). Next we analyzed the relation between intestinal cell damage and the development of inflammation. Concentrations of i-FABP at admittance correlated positively with values of IL-6 (r2 = 0.19, P < 0.01; Figure 4b) and PCT (r2 = 0.36, P < 0.001, Figure 4c) on the first day after trauma. Furthermore, early i-FABP levels correlated with CRP in plasma at the second day (r2 = 0.25, P < 0.01; Figure 4d).


Rapid development of intestinal cell damage following severe trauma: a prospective observational cohort study.

de Haan JJ, Lubbers T, Derikx JP, Relja B, Henrich D, Greve JW, Marzi I, Buurman WA - Crit Care (2009)

Intestinal mucosal cell damage after trauma correlates positively with the inflammatory response. (a) Peak concentrations of circulating IL-6 and procalcitonin (PCT) were reached at the first day after trauma, whereas highest levels of C-reactive protein (CRP) were measured at the second day (all parameters: * P < 0.05 vs. emergency room (ER); † P < 0.001 vs. day 1). (b to d) i-FABP concentrations at ER correlated positively with peak concentrations of IL-6 (r2 = 0.19, P < 0.01), PCT (r2 = 0.36, P < 0.001), and CRP (r2 = 0.25, P < 0.01). All data are shown in natural logarithmic scale.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2717456&req=5

Figure 4: Intestinal mucosal cell damage after trauma correlates positively with the inflammatory response. (a) Peak concentrations of circulating IL-6 and procalcitonin (PCT) were reached at the first day after trauma, whereas highest levels of C-reactive protein (CRP) were measured at the second day (all parameters: * P < 0.05 vs. emergency room (ER); † P < 0.001 vs. day 1). (b to d) i-FABP concentrations at ER correlated positively with peak concentrations of IL-6 (r2 = 0.19, P < 0.01), PCT (r2 = 0.36, P < 0.001), and CRP (r2 = 0.25, P < 0.01). All data are shown in natural logarithmic scale.
Mentions: Circulating levels of IL-6, PCT, and CRP were measured on arrival at the ER and at the following days to explore the inflammatory response following trauma. Plasma IL-6 strongly increased at the first day (0.11 (0.01 to 18.35) ng/mL vs. ER: 0.04 (0.00 to 5.16) ng/mL, P < 0.05) and remained elevated at the second day (0.12 (0.00 to 11.37) ng/mL). Levels of PCT were barely detectable on presentation (0.06 (0.02 to 1.06) ng/mL), whereas elevated levels were measured at day 1 and 2 (0.22 (0.04 to 18.23) ng/mL and 0.22 (0.03 to 18.55) ng/mL, each P < 0.001 to ER). Consecutive measurements of acute phase protein CRP showed highest plasma values on the second day post-trauma (1.21 (0.06 to 2.72) mg/mL) compared with the first day (0.42 (0.05 to 1.57) mg/mL, P < 0.001) and to CRP concentrations on admittance (0.01 (0.00 to 0.28) mg/mL, P < 0.001; Figure 4a). Next we analyzed the relation between intestinal cell damage and the development of inflammation. Concentrations of i-FABP at admittance correlated positively with values of IL-6 (r2 = 0.19, P < 0.01; Figure 4b) and PCT (r2 = 0.36, P < 0.001, Figure 4c) on the first day after trauma. Furthermore, early i-FABP levels correlated with CRP in plasma at the second day (r2 = 0.25, P < 0.01; Figure 4d).

Bottom Line: Upon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01).The extent of intestinal damage is associated with the presence of shock and injury severity.Early intestinal damage precedes and is related to the subsequent developing inflammatory response.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, NUTRIM School for Nutrition, Toxicology and Metabolism, Maastricht University Medical Center, 6229 ER, Maastricht, The Netherlands. jj.dehaan@ah.unimaas.nl

ABSTRACT

Introduction: Loss of intestinal integrity has been implicated as an important contributor to the development of excessive inflammation following severe trauma. Thus far, clinical data concerning the occurrence and significance of intestinal damage after trauma remain scarce. This study investigates whether early intestinal epithelial cell damage occurs in trauma patients and, if present, whether such cell injury is related to shock, injury severity and the subsequent inflammatory response.

Methods: Prospective observational cohort study in 96 adult trauma patients. Upon arrival at the emergency room (ER) plasma levels of intestinal fatty acid binding protein (i-FABP), a specific marker for damage of differentiated enterocytes, were measured. Factors that potentially influence the development of intestinal cell damage after trauma were determined, including the presence of shock and the extent of abdominal trauma and general injury severity. Furthermore, early plasma levels of i-FABP were related to inflammatory markers interleukin-6 (IL-6), procalcitonin (PCT) and C-reactive protein (CRP).

Results: Upon arrival at the ER, plasma i-FABP levels were increased compared with healthy volunteers, especially in the presence of shock (P < 0.01). The elevation of i-FABP was related to the extent of abdominal trauma as well as general injury severity (P < 0.05). Circulatory i-FABP concentrations at ER correlated positively with IL-6 and PCT levels at the first day (r2 = 0.19; P < 0.01 and r2 = 0.36; P < 0.001 respectively) and CRP concentrations at the second day after trauma (r2 = 0.25; P < 0.01).

Conclusions: This study reveals early presence of intestinal epithelial cell damage in trauma patients. The extent of intestinal damage is associated with the presence of shock and injury severity. Early intestinal damage precedes and is related to the subsequent developing inflammatory response.

Show MeSH
Related in: MedlinePlus