Plasma levels of intestinal fatty acid-binding protein and citrulline are not associated with severe upper gastrointestinal ischemic lesions after out-of-hospital cardiac arrest: an ancillary study of the ENTRACT trial.

Background: Acute intestinal injury plays a major role in the pathophysiology of the post-cardiac arrest (CA) syndrome. Citrulline and intestinal fatty acid-binding protein (I-FABP) are associated with mesenteric ischemia but there is paucity of data regarding their association with upper gastrointestinal tract injury. Methods: We conducted an ancillary analysis of the prospective and multicentric ENTRACT study, in which all patients who remained mechanically ventilated during the first 5 days after out-of-hospital CA underwent an esophago-gastro-duodenoscopy. Patients with available biobank were enrolled and plasma citrulline and I-FABP and urinary I-FABP were measured to assess their association with the severity of upper gastrointestinal tract lesions. Results: The biobank was available for 125 patients, mostly men (75 %) with a median age of 64 [55-72] years. Clinical, biological and CA characteristics were similar between groups according to the presence of severe lesions, except for a higher dose of adrenaline received during cardiopulmonary resuscitation in patients with severe lesions. Plasma citrulline (15 [12.4-19] vs 16.7 [14-21] µmol/L, p = 0.09) and I-FABP (339 [184-1140] vs 493 [271-976] pg/mL, p = 0.50) did not differ according to severe lesions, although urinary I-FABP was higher in the severe lesion group (6560 [1190-18450] vs 2030 [685-7400] pg/mL, p = 0.04). Corresponding performance for prediction of severe upper GI lesions was poor regarding positive and negative predictive values. Conclusion: Citrulline and I-FABP did not reliably predict the presence of severe upper gastrointestinal tract ischemic injury observed during esophago-gastro-duodenoscopy performed within the first 5 days after an out-of-hospital CA.