Intestinal mucosal injury in critically ill surgical patients: Preliminaryobservations

This was a prospective study designed to evaluate the extent to which intes tinal mucosal compromise occurs in adult critical care patients with and wi thout systemic inflammatory response syndrome (SIRS) and to correlate the d egree of intestinal injury with outcome. Ten patients from a university hos pital surgical intensive care unit were identified who manifested SIRS at t he time of admission to the intensive care unit. Five other critical care p atients without SIRS were also evaluated. The Acute Physiology and Chronic Health Evaluation II score was determined. Intestinal mucosal viability was assessed by serial measurement of serum and urine iFABP intestinal fatty a cid binding protein (iFABP), a sensitive and specific marker for mucosal in jury. Outcome in terms of the development of multiorgan dysfunction syndrom e, adult respiratory distress syndrome, and survival was determined. iFABP was detectable in the serum or urine in 8 out of 10 patients with SIRS. Amo ng the 4 patients with detectable serum iFABP, 2 died and 1 developed sever e adult respiratory distress syndrome. Nine of 11 patients without detectab le serum iFABP recovered without major morbidity. iFABP was detectable in m ost patients with SIRS, suggesting that subclinical intestinal mucosal comp romise is a frequent component of this syndrome. When iFABP was detectable, particularly in the serum, the prognosis was poor, even in the absence of SIRS, indicating that iFABP may be a relevant and independent predictor of outcome in critical care patients.