Fibronectin. A new nutritional parameter.

Acute and chronic malnutrition is associated with increased morbidity and mortality in surgical patients. Plasma fibronectin levels have been shown to correlate with reticuloendothelial function and are reduced in burns, shock, trauma, and sepsis. Patients failing to show an increase in fibronectin levels after stress have been shown to do poorly. Starvation studies in human volunteers have demonstrated decreasing plasma fibronectin levels until feeding was resumed. The purpose of this study is to examine the usefulness of fibronectin as an assessment parameter in nutritionally depleted hospitalized patients. Eight patients initiated on parenteral nutrition were studied. Plasma fibronectin, albumin, and transferrin levels were drawn before TPN and repeated at various intervals after total parenteral nutrition (TPN) was begun. Mean pre-TPN transferrin was 198.1 +/- 16.1 gm/dl (nl 220-400). Transferrin levels remained statistically unchanged after 8 to 11 days of TPN. Mean pre-TPN albumin was 3.0 +/- 0.2 gm/dl (nl 3.6-4.8) and also remained statistically unchanged after 8 to 11 days of TPN. The mean fibronectin level pre-TPN was 236.4 +/- 24.4 microgram/ml (nl 370-410). Fibronectin rose statistically (P less than 0.005) after 1 to 4 days of TPN to a mean of 341.9 +/- 30.1 microgram/ml and remained elevated and statistically unchanged after 8 to 11 days of TPN. Six of the eight patients studied survived and had demonstrated at least a 30 per cent increase in fibronectin after 1 to 4 days of TPN. Both patients who died demonstrated minimal increase in fibronectin levels after 1 to 4 days of TPN.(ABSTRACT TRUNCATED AT 250 WORDS)