Organ failure, infection, and the systemic inflammatory response syndrome are associated with elevated levels of urinary intestinal fatty acid binding protein: study of 100 consecutive patients in a surgical intensive care unit.

BACKGROUND: Intestinal mucosal ischemia and subsequent barrier dysfunction have been related to the development of organ dysfunction and death in the critically ill. We hypothesized that urine concentrations of intestinal fatty acid binding protein (IFABP), a sensitive marker of intestinal ischemia, might predict the development of the systemic inflammatory response syndrome (SIRS) and organ dysfunction. METHODS: One hundred consecutive critically ill patients were prospectively studied for the development of infectious complications, organ dysfunction, and SIRS. Urine was collected daily for measurement of IFABP. RESULTS: A total of 58 males and 42 females (mean age, 56 years; range,16-85 years) were studied. Of these 100 patients, 40 patients developed complications and 5 patients developed SIRS. IFABP was significantly elevated in all patients with SIRS, and IFABP levels peaked an average of 1.4 days (range, 0-7 days) before the diagnosis of SIRS. CONCLUSION: Elevated concentrations of urine IFABP correlated with the clinical development of SIRS. Studies to assess the utility of IFABP as a predictor of organ dysfunction and SIRS in the critically ill are warranted.

Early fracture fixation may be deleterious after head injury.

OBJECTIVE: To determine the neurologic risks associated with early fracture fixation (FF) in multitrauma patients with head injuries. METHODS: We reviewed 33 blunt trauma patients with significant closed head injuries (Abbreviated Injury Scale (AIS) score > or = 2) requiring operative FF. Nineteen patients underwent early FF defined as < or = 24 hours after injury, and 14 patients underwent late FF defined as > 24 hours after injury. The two groups were well matched in regards to age, 40.3 years (range, 8-88 years) versus 36.4 years (range, 8-75 years), admission Glasgow Coma Scale score (12 +/- 4 vs. 11 +/- 5), and Injury Severity Score (25 +/- 10 vs. 27 +/- 12). Additionally, the groups had similar neurologic and orthopedic injury scores (AIS-CNS score = 3.3 +/- 0.9 vs. 3.1 +/- 0.9, AIS-Ortho score = 3.0 +/- 0.9 vs. 2.9 +/- 0.7). Data were collected concerning the volume of fluid resuscitation, neurologic complications, and clinical outcomes. RESULTS: The early FF group received significantly more fluids in the first 48 hours (14.0 +/- 10.2 vs. 8.7 +/- 3.5 liters, p < 0.05). The early group trended towards a higher rate of intraoperative hypotension (systolic blood pressure < 90 mm Hg, 16% vs. 7%) and intraoperative hypoxia (O2-Saturation < or = 90, 11% vs. 7%). The neurologic complication rate was similar in the two groups (early FF = 16% vs. late FF = 21%), but the average discharge Glasgow Coma Scale score was lower in the early group (13.5 +/- 3.7) when compared with the late FF patient group (15.0 +/- 0.0). CONCLUSIONS: Early FF leads to greater fluid administration in patients with head injuries. Hypoxemia and hypotension, risk factors for secondary brain injury, may contribute to a poor neurologic outcome after early fixation. Prospective studies evaluating the impact of the timing of FF on head injury are indicated.