Novosti
Khirurgii
This journal is
indexed in Scopus









Year 2019 Vol. 27 No 6

SCIENTIFIC PUBLICATIONS
GENERAL & SPECIAL SURGE

DOI: https://dx.doi.org/10.18484/2305-0047.2019.6.640   |  

I.A. KRYVORUCHKO 1, V.V. BOYKO 1, 2, N.N. HONCHAROVA 1, I.A. TARABAN 1, O.V. ARSENYEV 3, JU.V. IVANOVA 1, 2, D.A. SMETSKOV 4, 5, A.G. DROZDOVA 5

EVALUATION OF INTESTINAL BARRIER BIOMARKER I-FABP AND SEVERITY OF PATIENTS IN ACUTE PANCREATITIS

Kharkiv National Medical University 1,
V.T. Zaytsev Institute of General and Emergency Surgery 2,
National University of Pharmacy 3,
Kharkiv Regional Clinical Hospital 4,
Kharkiv Medical Academy of Postgraduate Education 5, Kharkiv,
Ukraine

Objective. To determine the possibility of using I-FABP together with indicators of the abdominal cavity perfusion pressure to diagnose damages of digestive tract and to assess the acute pancreatitis severity.
Methods. A prospective, single-center controlled study was conducted in 58 patients. The dynamics of clinical and laboratory parameters, APACHE II score, AGI grade and parameters of the abdominal perfusion pressure in all patients were evaluated as well as I-FABP changes in 27 (46.6%) on admission and 48 hours after their complex treatment.
Results. The level of I-FABP in the serum after 48 hours increased by 69.8% on average, showed good accuracy for predicting the damage severity to the digestive tract after 48 hours compared with the initial level of AGI grade (area under the ROC curve 0.913) at the threshold value I-FABP 1350 pg/ml with a sensitivity of 0.95 and a specificity of 0.9. A good predictive value was found between the APACHE II score and the level of perfusion pressure in the abdomen when patients were admitted (area under the ROC-curve 0.889) and after 48 hours (the area under the ROC-curve 0.929) for complex treatment. It is established that the severity of the patients condition on the APACHE II scale can be predicted by the level of perfusion pressure when patients are admitted (threshold value 72.1 mm Hg, sensitivity 0.82, specificity 0.83) and after 48 hours of complex treatment (threshold 62 mm Hg, sensitivity 0.86, specificity 0.92).
Conclusions. Serum I-FABP is a valuable, convenient, objectively early predictor of the digestive tract damage in acute pancreatitis. The severity of patients condition can be predicted not only by using the APACHE II score, but also by evaluating the perfusion pressure in the abdominal cavity in the course of complex intensive therapy.

Keywords: acute pancreatitis, I-FABP, APACHE II score, AGI grade, abdominal perfusion pressure, surgery
p. 640-649 of the original issue
References
  1. Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009 Mar;53(3):318-24. doi: 10.1111/j.1399-6576.2008.01860.x
  2. Piton G, Belon F, Cypriani B, Regnard J, Puyraveau M, Manzon C, Navellou JC, Capellier G. Enterocyte damage in critically ill patients is associated with shock condition and 28-day mortality. Crit Care Med. 2013 Sep;41(9):2169-76. doi: 10.1097/CCM.0b013e31828c26b5
  3. Reintam A, Parm P, Kitus R, Starkopf J, Kern H. Gastrointestinal failure score in critically ill patients: a prospective observational study. Crit Care. 2008;12(4):R90. doi: 10.1186/cc6958
  4. Reintam A, Parm P, Redlich U, Tooding LM, Starkopf J, Köhler F, Spies C, Kern H. Gastrointestinal failure in intensive care: a retrospective clinical study in three different intensive care units in Germany and Estonia. BMC Gastroenterol. 2006 Jun 22;6:19. doi: 10.1186/1471-230X-6-19
  5. Blaser A, Malbrain M, Starkopf J, Fruhwald S, Jakob S, De Waele J, Braun J, Poeze M, Spies C. Gastrointestinal function in intensive care patients: Terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012;38:384-94. doi: 10.1007/s00134-011-2459-y
  6. Grootjans J, Thuijls G, Verdam F, Derikx JP, Lenaerts K, Buurman WA. Non-invasive assessment of barrier integrity and function of the human gut. World J Gastrointest Surg. 2010 Mar 27;2(3):61-69. doi: 10.4240/wjgs.v2.i3.61
  7. Schroeder F, Jolly CA, Cho TH, Frolov A. Fatty acid binding protein isoforms: structure and function. Chem Phys Lipids. 1998 Mar;92(1):1-25. doi: 10.1016/S0009-3084(98)00003-6
  8. Pelsers MM, Hermens WT, Glatz JF. Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta. 2005 Feb;352(1-2):15-35. doi: 10.1016/j.cccn.2004.09.001
  9. Li H, Chen Y, Huo F, Wang Y, Zhang D. Association between acute gastrointestinal injury and biomarkers of intestinal barrier function in critically ill patients. BMC Gastroenterology. 2017;17:45 doi: 10.1186/s12876-017-0603-z
  10. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis 2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. doi: 10.1136/gutjnl-2012-302779
  11. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Working Group IAP/APA Acute Pancreatitis Guidelines. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15. doi: 10.1016/j.pan.2013.07.063
  12. Kron IL, Harman PK, Nolan SP. The measurement of intra-abdominal pressure as a criterion for abdominal re-exploration. Ann Surg. 1984 Jan;199(1):28-30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1353253/
  13. Boiko VV, Krivoruchko IA, Shevchenko RS, Smachilo RM, Pesotskii ON. Ostryi pankreatit. Patofiziologiia i lechenie. Kharkov, Ukraina: Tornado; 2002. 258 p. http://www.booksmed.com/hirurgiya/515-ostryj-pankreatit-patofiziologiya-i-lechenie.html (In Ukr.)
  14. Kitai T, Kim YH, Kiefer K, Morales R, Borowski AG, Grodin JL, Tang WHW. Circulating intestinal fatty acid-binding protein (I-FABP) levels in acute decompensated heart failure. Clin Biochem. 2017 Jun;50(9):491-95. doi: 10.1016/j.clinbiochem.2017.02.014
  15. Grimaldi D, Guivarch E, Neveux N, Fichet J, Pène F, Marx JS, Chiche JD, Cynober L, Mira JP, Cariou A. Markers of intestinal injury are associated with endotoxemia in successfully resuscitated patients. Resuscitation. 2013 Jan;84(1):60-65. doi: 10.1016/j.resuscitation.2012.06.010
  16. Sekino M, Funaoka H, Sato S, Okada K, Inoue H, Yano R, Matsumoto S, Ichinomiya T, Higashijima U, Matsumoto S, Hara T. Intestinal fatty acid-binding protein level as a predictor of 28-day mortality and bowel ischemia in patients with septic shock: A preliminary study. J Crit Care. 2017 Dec;42:92-100. doi: 10.1016/j.jcrc.2017.07.012
Address for correspondence:
61022, Ukraine,
Kharkiv, Nauki Ave., 4,
Kharkiv National Medical University,
Surgery Department 2.
Tel.: +38-050-301-90-90,
+38-057-705-02-45,
e-mail: ikryvoruchko60@gmail.com,
Igor A. Kryvoruchko
Information about the authors:
Kryvoruchko Igor A., MD, Professor, Head of the Surgery Department 2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5525-701X
Boyko Valeriy V., Corresponding Member of NAMS of Ukraine, MD, Professor, Director of V.T. Zaytsev Institute of General and Emergency Surgery, Head of the Surgery Department 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-3455-9705
Honcharova Natalya N., MD, Associate Professor, Professor of the Surgery Department 2, Kharkiv National Medical University, Kharkiv, Ukraine.
http://orcid.org/0000-0001-5031-7311
Taraban Igor A., MD, Professor of the Surgery Department 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5842-2551
Arsenyev leksandr V., PhD, Associate Professor of the Pharmacokinetics Department, National University of Pharmacy, Kharkiv, Ukraine.
https://orcid.org/0000-0002-9807-0853
Ivanova Julia V., MD, Leading Researcher, V.T. Zaytsev Institute of General and Emergency Surgery, Professor of the Surgery Department 1, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0001-8773-6827
Smetskov Dmytro A., PhD, Head of the Operative Unit of Kharkiv Regional Clinical Hospital, Associate Professor of the Department of Endoscopy and Surgery of Kharkiv Medical Academy of Postgraduate Education, Kharkiv, Ukraine.
https://orcid.org/0000-0002-5004-2255
Drozdova Anastasiya G., Post-Graduate Student of the Surgery Department 2, Kharkiv National Medical University, Kharkiv, Ukraine.
https://orcid.org/0000-0002-4401-8048
Contacts | ©Vitebsk State Medical University, 2007