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Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients
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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“and secondary to increased intestinal permeability resulting from extreme physiologic stress,32 ethanol exposure,33 or a “fast-food style” Western diet, high in both carbohydrate and saturated fat.34”
From The Gut Microbiome and the Brain (2014) · cites this paper as [32]
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Metadata
- 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)
- Venue
- Resuscitation
- Publisher
- Elsevier BV
- Published
- 2013-01
- Volume
- 84
- Issue
- 1
- Pages
- 60-65
- ISSN
- 0300-9572 (ISSN-L)
- 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
- 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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