Motohiro Sekino1, Hiroyuki Funaoka2, Shuntaro Sato3, Kyoko Okada4, Haruka Inoue5, Rintaro Yano6, Sojiro Matsumoto7, Taiga Ichinomiya8, Ushio Higashijima9, Shuhei Matsumoto10, Tetsuya Hara11. 1. Division of Intensive Care, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: m-sekino@nagasaki-u.ac.jp. 2. DS Pharma Biomedical Co., Ltd., 33-94 Enoki-cho, Suita, Osaka 564-0053, Japan. Electronic address: hiroyuki-funaoka@bio.ds-pharma.co.jp. 3. Clinical Research Center, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: shuntarosato@nagasaki-u.ac.jp. 4. Department of Anesthesiology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: mykyo@nagasaki-u.ac.jp. 5. Division of Intensive Care, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: hinoue@nagasaki-u.ac.jp. 6. Division of Intensive Care, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: ryano@nagasaki-u.ac.jp. 7. Division of Intensive Care, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: s-matsumoto@nagasaki-u.ac.jp. 8. Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: taiga@nagasaki-u.ac.jp. 9. Division of Intensive Care, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: ushioh@nagasaki-u.ac.jp. 10. Division of Intensive Care, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: shumtmt@nagasaki-u.ac.jp. 11. Department of Anesthesiology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. Electronic address: tetsuya@nagasaki-u.ac.jp.
Abstract
PURPOSE: We sought to evaluate the levels of intestinal fatty acid-binding protein (I-FABP), a biomarker of enterocyte injury, as a predictor of 28-day mortality and bowel ischemia in septic shock patients. MATERIAL AND METHODS: In this preliminary prospective observational study, 57 adult septic shock patients under mechanical ventilation were enrolled. Serum I-FABP levels and prognostic biomarkers were recorded upon intensive care unit (ICU) admission. RESULTS: The overall 28-day mortality rate of participants was 23% (13/57). Non-survivors displayed significantly higher lactate (p=0.009), I-FABP (p=0.012), and N-terminal pro-B-type natriuretic peptide (p=0.039) levels compared to survivors. Only I-FABP was associated with 28-day mortality (odds ratio, 1.036; 95% confidence interval, 1.003-1.069; p=0.031) in a multiple logistic regression analysis adjusted for the Acute Physiology and Chronic Health Evaluation II score. When divided into low and high I-FABP groups based on the optimum cut-off value of 19.0ng/mL for predicting 28-day mortality, high-I-FABP patients had a significantly higher incidence of non-occlusive mesenteric ischemia (NOMI) (2% [1/43] vs 29% [4/14]; p=0.011). CONCLUSIONS: I-FABP level at ICU admission can serve as a predictor of 28-day mortality in septic shock patients and is associated with the incidence of NOMI.
PURPOSE: We sought to evaluate the levels of intestinal fatty acid-binding protein (I-FABP), a biomarker of enterocyte injury, as a predictor of 28-day mortality and bowel ischemia in septic shockpatients. MATERIAL AND METHODS: In this preliminary prospective observational study, 57 adult septic shockpatients under mechanical ventilation were enrolled. Serum I-FABP levels and prognostic biomarkers were recorded upon intensive care unit (ICU) admission. RESULTS: The overall 28-day mortality rate of participants was 23% (13/57). Non-survivors displayed significantly higher lactate (p=0.009), I-FABP (p=0.012), and N-terminal pro-B-type natriuretic peptide (p=0.039) levels compared to survivors. Only I-FABP was associated with 28-day mortality (odds ratio, 1.036; 95% confidence interval, 1.003-1.069; p=0.031) in a multiple logistic regression analysis adjusted for the Acute Physiology and Chronic Health Evaluation II score. When divided into low and high I-FABP groups based on the optimum cut-off value of 19.0ng/mL for predicting 28-day mortality, high-I-FABPpatients had a significantly higher incidence of non-occlusive mesenteric ischemia (NOMI) (2% [1/43] vs 29% [4/14]; p=0.011). CONCLUSIONS:I-FABP level at ICU admission can serve as a predictor of 28-day mortality in septic shockpatients and is associated with the incidence of NOMI.
Authors: Saarwaani Vallabhajosyula; Zhen Wang; M Hassan Murad; Shashaank Vallabhajosyula; Pranathi R Sundaragiri; Kianoush Kashani; Wayne L Miller; Allan S Jaffe; Saraschandra Vallabhajosyula Journal: Mayo Clin Proc Innov Qual Outcomes Date: 2020-01-08