Intestinal fatty acid binding protein as a marker for intra-abdominal pressure-related complications in patients admitted to the intensive care unit; study protocol for a prospective cohort study (I-Fabulous study)

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Esther M M Van Lieshout³  Peter Pickkers¹  Michael H J Verhofstad³  Samir Ali³  Ben Van der Hoven²  Oscar J F Van Waes³  Steven G Strang³ 

[1] Department of Intensive Care Medicine, Radboud University Medical Center, Nijmegen, The Netherlands;Department of Intensive Care Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, The Netherlands;Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, 3000 CA, The Netherlands

关键词: Risk factors;    Intra-abdominal pressure;    Intra-abdominal hypertension;    Intestinal integrity;    Intensive Care Unit;    Critical care medicine;    Biomarker;    Abdominal Compartment Syndrome;   

Others  :  1132268
DOI  :  10.1186/s13049-015-0088-0

 received in 2014-08-07, accepted in 2015-01-05,  发布年份 2015

【 摘 要 】

Background

Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have detrimental effects on all organ systems and are associated with increased morbidity and mortality in critically ill patients admitted to an intensive care unit. Intra-bladder measurement of the intra-abdominal pressure (IAP) is currently the gold standard. However, IAH is not always indicative of intestinal ischemia, which is an early and rapidly developing complication. Sensitive biomarkers for intestinal ischemia are needed to be able to intervene before damage becomes irreversible. Gut wall integrity loss, including epithelial cell disruption and tight junctions breakdown, is an early event in intestinal damage. Intestinal Fatty Acid Binding Protein (I-FABP) is excreted in urine and blood specifically from damaged intestinal epithelial cells. Claudin-3 is a specific protein which is excreted in urine following disruption of intercellular tight junctions. This study aims to investigate if I-FABP and Claudin-3 can be used as a diagnostic tool for identifying patients at risk for IAP-related complications.

Methods/Design

In a multicenter, prospective cohort study 200 adult patients admitted to the intensive care unit with at least two risk factors for IAH as defined by the World Society of the Abdominal Compartment Syndrome (WSACS) will be included. Patients in whom an intra-bladder IAP measurement is contra-indicated or impossible and patients with inflammatory bowel diseases that may affect I-FABP levels will be excluded. The IAP will be measured using an intra-bladder technique. During the subsequent 72 hours, the IAP measurement will be repeated every six hours. At these time points, a urine and serum sample will be collected for measurement of I-FABP and Claudin-3 levels. Clinical outcome of patients during their stay at the intensive care unit will be monitored using the Sequential Organ Failure Assessment (SOFA) score.

Discussion

Successful completion of this trial will provide evidence on the eventual role of the biomarkers I-FABP and Claudin-3 in predicting the risk of IAP-associated adverse outcome. This may aid early (surgical) intervention.

Trial registration

The trial is registered at the Netherlands Trial Register (NTR4638 webcite).

【 授权许可】

   
2015 Strang et al.; licensee BioMed Central.

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