Ho Sai-Wai, Chang Shi-Chuan, Chen Lee-Wei
Clin Lab. 2016 Nov 1;62(11):2219-2226. doi: 10.7754/Clin.Lab.2016.160430.
Urinary intestine fatty acid binding protein (U-IFABP) is a biomarker for gut injury. Previous studies showed that enterocyte damage in critically ill patients was common and appeared to be associated with poor prognosis. However, the impact of enterocyte damage on the outcome of critically ill patients with pneumonia has not yet been well investigated. The aim of the study is to evaluate the prognostic value of U-IFABP in critically ill patients with pneumonia.
A prospective observational study was performed in the intensive care unit (ICU) from September 1, 2013 to April 30, 2014. Pneumonia patients were divided into survival and non-survival groups. U-IFABP was measured using enzyme linked immunosorbent assay for 7 consecutive days after admission to ICU and expressed as U-IFABP/urine creatinine ratio. The prognostic value was tested by Receiver Operator Characteristic (ROC) curves and Kaplan-Meier curves.
A total of 32 pneumonia patients with endotracheal intubation were enrolled. U-IFABP/Cr levels were significantly higher in non-survivors than in survivors at day 1 (p = 0.033), day 4 (p = 0.018), day 5 (p = 0.008), day 6 (p = 0.006) and day 7 (p = 0.008) after ICU admission. The areas under ROC curve in predicting mortality were 0.755 (D1), 0.781 (D4), 0.812 (D5), 0.823 (D6), and 0.812 (D7). Moreover, pneumonia patients with day 7 U-IFABP/Cr above the cutoff of 28.9 pg/100 µL had a significantly lower survival rate (p = 0.043).
Enterocyte injury was common in critically ill patients with pneumonia. The severity of enterocyte injury, as evidenced by the U-IFABP/Cr, was associated with the patient's mortality. U-IFABP/Cr may serve as a significant prognostic factor for patients with pneumonia admitted to ICU. Further studies with larger populations are needed to verify these issues.
尿肠脂肪酸结合蛋白（U-IFABP）是肠道损伤的生物标志物。既往研究表明，重症患者的肠上皮细胞损伤很常见，且似乎与预后不良有关。然而，肠上皮细胞损伤对重症肺炎患者预后的影响尚未得到充分研究。本研究的目的是评估U-IFABP在重症肺炎患者中的预后价值。
于2013年9月1日至2014年4月30日在重症监护病房（ICU）进行了一项前瞻性观察研究。将肺炎患者分为存活组和非存活组。在入住ICU后连续7天使用酶联免疫吸附测定法检测U-IFABP，并以U-IFABP/尿肌酐比值表示。通过受试者工作特征（ROC）曲线和Kaplan-Meier曲线检验预后价值。
共纳入32例接受气管插管的肺炎患者。入住ICU后第1天（p = 0.033）、第4天（p = 0.018）、第5天（p = 0.008）、第6天（p = 0.006）和第7天（p = 0.008），非存活者的U-IFABP/Cr水平显著高于存活者。预测死亡率的ROC曲线下面积分别为0.755（第1天）、0.781（第4天）、0.812（第5天）、0.823（第6天）和0.812（第7天）。此外，第7天U-IFABP/Cr高于28.9 pg/100 µL临界值的肺炎患者生存率显著较低（p = 0.043）。
重症肺炎患者中肠上皮细胞损伤很常见。U-IFABP/Cr所证实的肠上皮细胞损伤严重程度与患者死亡率相关。U-IFABP/Cr可能是入住ICU的肺炎患者的一个重要预后因素。需要进一步进行更大规模人群的研究来验证这些问题。
