Clinical Significance Of Serum Intestinal Fatty Acid-binding Protein And D-lactic Acid Levels In Early Intestinal Injury Of Patients With Sepsis

Objective To investigate the changes and clinical significances of intestinal fatty acid-binding protein(I-FABP)and D-lactic acid levels in early intestinal injury of patients with sepsis and septic shock.Methods A prospective observational study was conducted.Thirty septic patients(septic group)and 30 septic shock patients(septic shock group)were admitted to the intensive care unit(ICU)of General Hospital of Ningxia Medical University from August 2018 to December 2018,and 20 healthy adults were served as the healthy control group.Serum samples were collected within 24 hours after ICU admission in septic shock and septic groups,and in healthy control group during physical examination.The serum I-FABP,D-lactic acid,endotoxin,hypersensitive C-reactive protein(hs-CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and lactic acid(Lac)were determined.Gender and age of all subjects,and basic diseases,the main area of infection and acute physiology and chronic health evaluationⅡ(APACHEⅡ)scores within 24 hours after ICU admission of all patients were recorded.At the same time,the survival of the patients was followed up for 28 days.Sepsis and septic shock patients were divided into non-abdominal infection group and abdominal infection group according to the infected site,and survival group and death group according to the 28-day survival condition.Serum I-FABP and D-lactic acid levels between the groups were compared.Spearman correlation analysis was used to analyze the correlation between serumI-FABP,D-lactic acid and other parameters.Risk factors of death in patients with sepsis and septic shock were screened by multivariate Logistic regression analysis of categorized variables.Results There was no significant difference in gender or age among the groups,as well as in the proportion of basic diseases,celiac infection or non-celiac infection between the sepsis group and the septic shock group,indicating that the general clinical baseline data among the groups were comparable.Serum levels of I-FABP and D-lactic acid in the sepsis group and the septic shock group were significantly higher than those in the healthy control group [I-FABP(μg/L): 27.46(22.52,34.39),36.95(29.82,44.24)vs.17.93(14.65,22.11),D-lactic acid(mg/L): 15.32(9.84,38.62),27.95(10.01,47.69)vs.9.38(8.81,14.48),all P <0.01].The serum level of I-FABP in the septic shock group was significantly higher than that in the sepsis group(P < 0.05),but the difference in serum D-lactic acid level between the two groups was not statistically significant(P > 0.05).Serum I-FABP level in the celiac infection group(n = 40)was significantly higher than that in the non-celiac infection group [n = 20;μg/L: 34.76(27.46,43.90)vs.25.71(20.55,37.77),P < 0.01],but the difference in serum D-lactic acid level was not statistically significant [mg/L: 25.13(9.83,40.55)vs.30.36(10.17,50.00),P > 0.05].There was no significant difference in serum I-FABP or D-lactic acid levels between the survival group(n = 34)and the death group [n = 26;I-FABP(μg/L): 33.39(25.20,39.50)vs.29.26(22.50,43.81),D-lactic acid(mg/L): 14.83(9.71,38.45)vs.33.90(11.93,45.34),both P > 0.05].Correlation analysis between serum I-FABP,D-lactic acid level and endotoxin,inflammatory factors,Lac and APACHE Ⅱ score in septic and septic shock patients showed that only D-lactic acid was significantly positively correlated with TNF-α and Lac(r values were 0.455 and 0.406,respectively,both P < 0.01),while I-FABP was not correlated with endotoxin,inflammatory factors,Lac or APACHE Ⅱ score(all P > 0.05).Multivariable Logistic regression analysis showed the APACHEⅡ score was an independentrisk factor to affect the prognosis(death for 28 days)of septic and septic shock patients [odds ratio(OR)= 1.248,95% confidence interval(95%CI)= 1.091-1.427,P = 0.001],while I-FABP,D-lactic acid,endotoxin,hs-CRP,TNF-α,IL-6,and Lac had no impact on 28-day prognosis of patients(all P > 0.05).Conclusion Serum I-FABP and D-lactic acid levels can be used as biomarkers to evaluate early intestinal injury in sepsis and septic shock,both of which indicate that intestinal injury can occur in patients at the early stage(≤24 hours).