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Intestinal fatty acid‐binding protein and acute gastrointestinal injury grade in postoperative cardiac surgery patients
Author(s) -
Seilitz Jenny,
Edström Måns,
Kasim Alhamsa,
Jansson Kjell,
Axelsson Birger,
Nilsson Kristofer F.
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15430
Subject(s) - medicine , quartile , gastrointestinal function , organ dysfunction , gastroenterology , gastrointestinal tract , surgery , confidence interval , sepsis
Background and Aim Gastrointestinal complications post cardiac surgery are infrequent but difficult to diagnose and carry a high mortality. Plasma intestinal fatty acid‐binding protein (I‐FABP) concentrations and the relationship between I‐FABP, gastrointestinal dysfunction, and postoperative outcomes were investigated in patients who developed gastrointestinal dysfunction (acute gastrointestinal injury [AGI] grade ≥2) and those with normal gastrointestinal function. Methods Patients with (AGI 2 group, n = 11) and without (matched controls, AGI 0 group, n = 22) early postoperative gastrointestinal dysfunction were extracted from a larger single‐center prospective observational study, including adults undergoing elective cardiac surgery with extracorporeal circulation, and investigated in this nested case‐control analysis. Results Both groups displayed variations in I‐FABP concentrations with higher I‐FABP on postoperative Day 1 compared to baseline and postoperative Days 2 and 3 ( p < .001 and p = .005, respectively). The AGI 2 group had higher I‐FABP concentrations on Day 2 compared to the AGI 0 group ( p = .024). I‐FABP on Day 2 correlated positively with AGI grade over the first 3 days ( p = .036, p = .021 and p = .018, respectively). High I‐FABP (defined as fourth quartile concentrations) on Day 1 was associated with more prolonged surgical procedures ( p < .05). Furthermore, fourth quartile I‐FABP on Day 1 and early gastrointestinal dysfunction were associated with higher frequencies of postoperative organ dysfunction ( p < .05) and gastrointestinal complications ( p < .05), and higher 365‐day mortality. Conclusion The present study indicates an association between intraoperative gastrointestinal injury, postoperative gastrointestinal dysfunction and gastrointestinal complications. A high‐powered study is needed to further explore this relationship and the interpretation of I‐FABP concentrations in individual cardiac surgery patients.