Key result
Early postoperative GI dysfunction is linked to higher day 2 I-FABP levels.
Why the study?
Gastrointestinal complications after cardiac surgery are infrequent, difficult to diagnose, and associated with high mortality, necessitating investigation of biomarkers like I-FABP.
Case-Control (n=33)
No
p-value: p=0.024
Elevated plasma I-FABP concentrations in the early postoperative period after cardiac surgery correlate with acute gastrointestinal injury and worse clinical outcomes, suggesting its potential utility as a biomarker for gastrointestinal complications.
I-FABP may flag gastrointestinal injury risk after cardiac surgery; hypothesis-generating and should not yet change practice.
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.
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Seilitz et al. (2021) conducted a case-control in Postoperative gastrointestinal dysfunction (n=33). Early postoperative gastrointestinal dysfunction (AGI grade ≥2) vs. Normal gastrointestinal function (AGI 0) was evaluated on I-FABP concentrations on postoperative Day 2 (p=0.024). Early postoperative gastrointestinal dysfunction was associated with higher I-FABP concentrations on postoperative Day 2 compared to normal gastrointestinal function (p=0.024).
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