Cited by 130Sepsis Diagnosis and TreatmentCardiac Arrest and ResuscitationAbdominal Surgery and Complications

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Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients

Grimaldi, D., Guivarch, E., Neveux, N., Fichet, J., Pène, F., Marx, J.-S., Chiche, J.-D., Cynober, L., Mira, J.-P., Cariou, A.·2013·Resuscitation

DOI 10.1016/j.resuscitation.2012.06.010

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Abstract

Aims Gut dysfunction is suspected to play a major role in the pathophysiology of post-resuscitation disease through an increase in intestinal permeability and endotoxin release. However this dysfunction often remains occult and is poorly investigated. The aim of this pilot study was to explore intestinal failure biomarkers in post-cardiac arrest patients and to correlate them with endotoxemia.Methods Following resuscitation after cardiac arrest, 21 patients were prospectively studied. Urinary intestinal fatty acid-binding protein (IFABP), which marks intestinal permeability, plasma citrulline, which reflects the functional enterocyte mass, and whole blood endotoxin were measured at admission, days 1-3 and 6. We explored the kinetics of release and the relationship between IFABP, citrulline and endotoxin values.Results IFABP was extremely high at admission and normalized at D3 (6668 pg/mL vs 39 pg/mL, p=0.01). Lowest median of citrulline (N=20-40 μmol/L) was attained at D2 (11 μmol/L at D2 vs 24 μmol/L at admission, p=0.01) and tended to normalize at D6 (21 μmol/L). During ICU stay, 86% of patients presented a detectable endotoxemia. Highest endotoxin level was positively correlated with highest IFABP level (R(2)=0.31, p=0.01) and was inversely correlated with lowest plasma citrulline levels (R(2)=0.55, p<0.001). Endotoxin levels increased between admission and D2 in patients with post-resuscitation shock, whereas it decreases in patients with no shock (median +0.33 EU vs -0.19 EU, p=0.03). Highest endotoxin level was positively correlated with D3 SOFA score (R(2)=0.45, p=0.004).Conclusion Biomarkers of intestinal injury are altered after cardiac arrest and are associated with endotoxemia. This could worsen post-resuscitation shock and organ failure.

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Authors: Grimaldi, D., Guivarch, E., Neveux, N., Fichet, J., Pène, F., Marx, J.-S., Chiche, J.-D., Cynober, L., Mira, J.-P., & Cariou, A.
Affiliations: Hôpital Cochin (FR)
Sorbonne Paris Cité (FR)
Inserm (FR)
ORCID: Grimaldi, D.
Neveux, N.
Pène, F.
Chiche, J.-D.
Mira, J.-P.
Cariou, A.
Venue: Resuscitation
Publisher: Elsevier BV
Published: 2013-01
Volume: 84
Issue: 1
Pages: 60-65
ISSN: 0300-9572 (ISSN-L)
DOI: 10.1016/j.resuscitation.2012.06.010
OpenAlex: W2119467481
Cited by: 130
References: 42
Citations by year: 2026: 4 · 2025: 11 · 2024: 7 · 2023: 11 · 2022: 13 · 2021: 8 · 2020: 9 · 2019: 13 · 2018: 7 · 2017: 10 · 2016: 10 · 2015: 10 · 2014: 8 · 2013: 9
FWCI: 6.44
Type: journal article
Language: en
Open access: closed
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations: Resuscitation (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Sepsis Diagnosis and Treatment
Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
Health Sciences › Medicine › Surgery › Abdominal Surgery and Complications
Keywords: endotoxemia, intestinal injury, cardiac arrest, intestinal fatty acid binding protein, citrulline, intestinal permeability, gastrointestinal dysfunction, endotoxin, SOFA score, organ failure, biomarkers
MeSH terms: Chromatography, High Pressure Liquid, Citrulline, Endotoxins, Enzyme-Linked Immunosorbent Assay, Female, Humans, Intestinal Mucosa, Intestines, Male, Middle Aged, Prospective Studies, Biomarkers, Cardiopulmonary Resuscitation, Statistics, Nonparametric, Endotoxemia, Luminescence, Fatty Acid-Binding Proteins, Out-of-Hospital Cardiac Arrest

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Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients

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