Small bowel damage is frequent but underdiagnosed among
critically ill patients with
shock. High
catecholamine doses may have a deleterious effect on mesenteric blood flow. Plasma
intestinal fatty acid-binding protein (I-FABP) concentration is a marker of enterocyte damage, whereas plasma
citrulline concentration is a marker of functional enterocyte mass. We hypothesized that high doses of
catecholamines in
critically ill patients may be associated with enterocyte damage. This study aimed to determine the link between
catecholamine use and dose with enterocyte damage. This is a prospective observational study performed in a large regional university teaching hospital.
Critically ill patients requiring
epinephrine and/or
norepinephrine at admission to a medical intensive care unit (ICU) were included, as well as controls not receiving
catecholamines. We evaluated at admission plasma I-FABP and
citrulline concentrations, abdominal perfusion pressure (APP), and variables relating to prognosis and treatment. Patients were categorized according to the quartiles of
catecholamine dose at ICU admission. Sixty
critically ill patients receiving
catecholamines and 27 not receiving
catecholamines were included. Plasma I-FABP was higher among patients receiving
catecholamine than in controls. Among patients receiving
catecholamines, a dose of 0.48 γ kg min or more at ICU admission was associated with a higher I-FABP concentration. A
Sepsis-related Organ Failure Assessment score higher than 11 and plasma I-FABP more than 524 pg mL at ICU admission were independently associated with 28-day mortality (odds ratio, 4.0 [1.24-12.95] and odds ratio, 4.90 [1.44-16.6], respectively).
Catecholamine use is associated with I-FABP elevation in
critically ill patients.
Critically ill patients receiving more than 0.48 γ kg min of
epinephrine and/or
norepinephrine at ICU admission have high I-FABP concentrations. This suggests that enterocyte damage reflects the severity of
shock, and an adverse effect of
catecholamines per se is possible.