Evidence for early presence of intestinal epithelial cell damage in multitrauma patients

Introduction

The present study investigates the presence of intestinal epithelial cell damage in multitrauma patients on admission. In trauma patients, the development of SIRS and sepsis are important determinants of clinical outcome. Intestinal damage is considered to play an important role in development of these inflammatory syndromes. However, clinical evidence remains scarce. Previously, in a rat model of hemorrhagic shock, we demonstrated that interventions reducing intestinal damage strongly attenuated the inflammatory response. In order to explore potential applicability of such therapies in trauma patients, the presence of early intestinal damage is assessed after trauma.

Methods

Trauma patients (n = 95) admitted to the emergency room (ER) were divided into four groups regarding the Injury Severity Score (ISS) and the presence of abdominal injury (+AI or -AI): ISS < 25 +AI (n = 27); ISS > 25 +AI (n = 26); ISS < 25 -AI (n = 24) and ISS > 25 -AI (n = 18). Plasma was obtained directly after admittance to the ER. Intestinal fatty acid binding protein (I-FABP), a cytosolic protein constitutively present in mature enterocytes and released after cellular damage, was measured by ELISA. Circulating procalcitonin (PCT), representing inflammation, was assessed by Kryptor assay.

Results

On admission, concentrations of I-FABP (1,395 ± 438 pg/ml) were significantly (P < 0.05) elevated in patients with ISS > 25 +AI compared with all other groups on admission (ISS > 25 -AI: 309 ± 67 pg/ml; ISS < 25 +AI: 531 ± 202 pg/ml; ISS < 25 -AI: 221 ± 46 pg/ml) (MWU). Noteworthy, I-FABP was significantly increased in patients without AI (ISS > 25) in comparison with 76 healthy volunteers (102 ± 12 pg/ml). On admission, I-FABP levels were correlated positive with ISS (Pearson r² = 0.28; P < 0.0001). Furthermore, I-FABP concentrations at ER correlated to PCT levels on day 1 (Pearson r² = 0.50; P < 0.0001).

Conclusion

This is the first study to provide evidence for rapid development of intestinal epithelial cell damage in severe multitrauma patients with and without abdominal trauma. The extent of early intestinal damage is associated with the inflammatory response present at 24 hours. Further studies are needed to determine whether therapies aimed at reduction of intestinal damage improve clinical outcome of patients with severe trauma.