Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria.
Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.
Shock. 2019 Apr;51(4):410-415. doi: 10.1097/SHK.0000000000001195.
Acute heart failure and cardiogenic shock are associated with an impaired intestinal perfusion, which may lead to a release of cytoplasmatic proteins by hypoxic epithelial injury. Intestinal fatty acid binding protein (iFABP), highly specific for the small bowel enterocyte, may pose a useful novel and very sensitive biomarker for predicting outcome of these patients.The aim of this study was to investigate whether circulating levels of iFABP are associated with mortality in patients with acute heart failure or cardiogenic shock requiring intensive care unit (ICU) admission.
We included 90 consecutive patients with cardiogenic shock (74.4%) or severe acute heart failure (25.6%) admitted to a cardiac ICU. Blood samples were taken at day 0 and day 3. Median age was 64.7 (49.4-74.3), 76.7% of patients were male and median NT-proBNP levels were 4,986 (1,525-23,842) pg/mL. 30-day survival was 64.4%.
Patients with serum levels of iFABP at day 0 in the highest quartile (iFABP ≥ 588.4 pg/mL) had a 2.5-fold risk (P = 0.02) of dying independent of demographics, NT-proBNP levels, and vasopressor use. Extensively elevated admission levels of iFABP above the 90th percentile (iFABP ≥ 10208.4 pg/mL) were associated with an excessive mortality rate of 88.9%. In contrast, iFABP levels at day 3 were not associated with outcome.
Circulating levels of iFABP at admission predict mortality. This suggests that early inadequate perfusion of the small intestine may be associated with a dramatically decreased survival in patients with cardiogenic shock or severe acute heart failure.
急性心力衰竭和心源性休克与肠道灌注受损有关，这可能导致缺氧上皮损伤释放细胞质蛋白。肠脂肪酸结合蛋白（iFABP）对小肠肠细胞具有高度特异性，可能是预测这些患者预后的一种有用的新型、非常敏感的生物标志物。本研究旨在探讨急性心力衰竭或心源性休克患者需入住重症监护病房（ICU）时，循环 iFABP 水平是否与死亡率相关。
我们纳入了 90 例连续的因心源性休克（74.4%）或严重急性心力衰竭（25.6%）入住心脏 ICU 的患者。分别在第 0 天和第 3 天采集血样。中位年龄为 64.7（49.4-74.3）岁，76.7%的患者为男性，中位 NT-proBNP 水平为 4986（1525-23842）pg/mL。30 天生存率为 64.4%。
第 0 天 iFABP 血清水平处于最高四分位数（iFABP≥588.4pg/mL）的患者死亡风险增加 2.5 倍（P=0.02），独立于人口统计学、NT-proBNP 水平和血管加压素使用。iFABP 入院水平显著升高（iFABP≥10208.4pg/mL）超过第 90 百分位数与死亡率过高（88.9%）相关。相反，第 3 天的 iFABP 水平与预后无关。
入院时循环 iFABP 水平可预测死亡率。这表明心源性休克或严重急性心力衰竭患者早期小肠灌注不足可能与生存率显著降低有关。
