Intestinal dysfunction in the critical trauma patients - An early and frequent event

• Autor(a) principal: Costa, Beatriz Pinto
• Data de Publicação: 2017
• Outros Autores: Martins, Paulo, Veríssimo, Carla, Simões, Marta, Tomé, Marisa, Grazina, Manuela, Pimentel, Jorge, Sousa, Francisco Castro
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/108294; https://doi.org/10.20960/nh.788
• topic: Citrulline; Intestinal dysfunction; Trauma; Mortality; Critically ill patients; Citrulina; Disfunción intestinal; Trauma; Mortalidad; Pacientes críticos; Adult; Aged; Aged, 80 and over; Amino Acids; Citrulline; Citrullinemia; Cohort Studies; Critical Illness; Female; Humans; Intestinal Diseases; Male; Middle Aged; Prevalence; Prospective Studies; Wounds and Injuries; Young Adult

Background: Small-bowel dysfunction exerts a relevant prognostic impact in the critically ill patients. Citrullinemia has been used in the evaluation of the intestinal function and it is considered an objective parameter of the functional enterocyte mass. Present study proposes to determine the intestinal dysfunction prevalence and the citrullinemia kinetic profi le in severe trauma patients and to investigate its correlation with severity indicators and clinical outcome. Methods: A prospective study including 23 critical trauma patients was performed. Aminoacidemias were quantifi ed, by ion exchange chromatography, at the admission and at the fi rst and third days. Severity and outcome parameters were registered. Results: In severe trauma patients, severe hypocitrullinemia (< 20 μmol/L) prevalence at admission was high (69.6%) and mean citrullinemia was low (19.5 ± 11.1 μmol/L). Baseline citrullinemia was inversely and signifi cantly correlated with shock index (r = -55.1%, p = 0.008) and extent of invasive ventilation support (r = -42.7%, p = 0.042). Citrullinemia < 13.7 μmol/L at admission, observed in 17.4% of patients, was associated with higher shock index (1.27 ± 0.10 versus 0.75 ± 0.18, p = 0.0001) and longer duration of invasive ventilation support (20.3 ± 7 versus 11.2 ± 7.1 days, p = 0.029) and intensive care unit stay (22 ± 5.9 versus 12.2 ± 8.8 days, p = 0.048). A citrullinemia decrease in the fi rst day after admittance superior to 12.7% constituted a signifi cant predictive factor of in-hospital mortality (75 versus 14.3%, p = 0.044; odds ratio = 7.8; accuracy = 65.2%; specifi city = 92.3%; negative predictive value = 85.7%] and lower actuarial survival (69.8 ± 41.6 versus 278.1 ± 37.4 days, p = 0.034). Conclusions: Those results confi rm the high prevalence and the prognostic relevance of hypocitrullinemia, considered a biomarker of enterocyte dysfunction, in severe trauma patients.