World Journal of Surgery

, Volume 41, Issue 12, pp 3120–3127 | Cite as

I-FABP is a Novel Marker for the Detection of Intestinal Injury in Severely Injured Trauma Patients

  • M. VothEmail author
  • M. Duchene
  • B. Auner
  • T. Lustenberger
  • B. Relja
  • I. Marzi
Original Scientific Report



Intestinal injury is a rare injury in multiply traumatized patients, and its diagnosis remains difficult. Delayed diagnosis of an intestinal injury increases the risk of sepsis, multiple organ failure and mortality. The intestinal fatty acid-binding protein (I-FABP) is solely expressed in the intestine and is released extracellulary after tissue damage. This study evaluates the validity of I-FABP as an early biomarker to detect an abdominal injury and particularly an injury to the intestine.

Patients and Methods

Patients with an Abbreviated Injury Scale (AIS) score for abdominal body region (AIS abdomen) ≥3 were included in this study from 07/2006 to 12/2014. Of those, ten patients retrospectively had an intestinal injury (int. injury). According to the Injury Severity Score and the AIS abdomen, corresponding patients with an abdominal injury but without an intestinal injury (no int. injury) were included for matched-pair analysis. Twenty healthy volunteers served as controls. Plasma I-FABP levels were measured at admission to the emergency room and up to 10 days daily (d1–d10).


Median I-FABP levels were significantly higher in the “int. injury” group compared to the “no int. injury” group [2101.0 pg/ml (IQR = 1248.1–4117.8) vs. 351.4 pg/ml (IQR = 287.6–963.3), p < 0.05]. Furthermore, I-FABP levels of both groups were significantly higher compared to the control group [Ctrl: 127.2 pg/ml (IQR = 57.4–310.6), p < 0.05]. The time course of I-FABP levels showed a peak on the day of admission and a decline to the control levels in the further post-traumatic course. The development of complications such as single- or multi-organ failure, sepsis, acute respiratory distress syndrome, pneumonia and mortality was higher in the “int. injury” group; however, this difference was not statistically significant.


This study confirmed our previous observation that I-FABP might be used as a suitable early biomarker for the detection of abdominal injuries in general. In addition and more specific, I-FABP may be a useful and promising parameter in the diagnosis of intestinal injuries.


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

Institutional Ethics Committee approval (167/05 and 176/07), in accordance with the Declaration of Helsinki and reported following the Strengthening the Reporting of Observational studies in Epidemiology, STROBE guidelines).

Supplementary material

268_2017_4124_MOESM1_ESM.docx (13 kb)
Supplementary material 1 (DOCX 13 kb)
268_2017_4124_MOESM2_ESM.docx (32 kb)
Supplementary material 2 (DOCX 31 kb)


  1. 1.
    TraumaRegister DGU® (2014) TR-DGU der Sektion NIS.
  2. 2.
    Nast-Kolb D, Waydhas C, Kastl S et al (1993) The role of an abdominal injury in follow-up of polytrauma patients. Chirurg 64:552–559PubMedGoogle Scholar
  3. 3.
    Heuer M, Hussmann B, Kaiser G et al (2012) Hollow organ injury and multiple trauma: treatment, course and outcome—an organ-specific evaluation of 1127 patients from the trauma registry of the DGU. Zentralbl Chir 139:445–451CrossRefPubMedGoogle Scholar
  4. 4.
    Allen GS, Moore FA, Cox CS et al (1998) Hollow visceral injury and blunt trauma. J Trauma 45:69–75CrossRefPubMedGoogle Scholar
  5. 5.
    Enderson BL, Maull KI (1991) Missed injuries. The trauma surgeon’s nemesis. Surg Clin North Am 71:399–418CrossRefPubMedGoogle Scholar
  6. 6.
    Schumpelick V, Ambacher T, Riesener KP (1999) Current therapy of injuries of the colon and retroperitoneum. Chirurg 70:1269–1277CrossRefPubMedGoogle Scholar
  7. 7.
    Osborn TM, Tracy JK, Dunne JR et al (2005) Epidemiology of sepsis in patients with traumatic injury. Crit Care Med 32:2234–2240CrossRefGoogle Scholar
  8. 8.
    Shebrain S, Zelada J, Lipsky AM et al (2006) Mesenteric injuries after blunt abdominal trauma: delay in diagnosis and increased morbidity. Am Surg 72:955–961PubMedGoogle Scholar
  9. 9.
    Sung CK, Kim KH (1996) Missed injuries in abdominal trauma. J Trauma 41:276–282CrossRefPubMedGoogle Scholar
  10. 10.
    Niederee MJ, Byrnes MC, Helmer SD et al (2003) Delay in diagnosis of hollow viscus injuries: effect on outcome. Am Surg 69:293–299PubMedGoogle Scholar
  11. 11.
    Malinoski DJ, Patel MS, Yakar DO et al (2010) A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma 69:84–87CrossRefPubMedGoogle Scholar
  12. 12.
    Helling TS, Wilson J, Augustosky K (2007) The utility of focused abdominal ultrasound in blunt abdominal trauma: a reappraisal. Am J Surg 194:728CrossRefPubMedGoogle Scholar
  13. 13.
    Liu M, Lee CH, P’eng FK (1993) Prospective comparison of diagnostic peritoneal lavage, computed tomographic scanning, and ultrasonography for the diagnosis of blunt abdominal trauma. J Trauma 35:267–270CrossRefPubMedGoogle Scholar
  14. 14.
    Tajoddini S, Vahdati SS (2013) Ultrasonographic diagnosis of abdominal free fluid: accuracy comparison of emergency physicians and radiologists. Eur J Trauma Emerg Surg 39:9–13CrossRefPubMedGoogle Scholar
  15. 15.
    Sherck J, Shatney C, Sensaki K et al (1994) The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg 168:670–675CrossRefPubMedGoogle Scholar
  16. 16.
    Hefny AF, Kunhivalappil FT, Matev N et al (2014) Usefulness of free intraperitoneal air detected by CT scan in diagnosing bowel perforation in blunt trauma: experience from a community-based hospital. Injury 46:100–104CrossRefPubMedGoogle Scholar
  17. 17.
    Joseph DK, Kunac A, Kinler RL et al (2013) Diagnosing blunt hollow viscus injury: is computed tomography the answer? Am J Surg 205:414–418CrossRefPubMedGoogle Scholar
  18. 18.
    Park M-H, Shin BS, Namgung H (2013) Diagnostic performance of 64-MDCT for blunt small bowel perforation. Clin Imaging 37:884–888CrossRefPubMedGoogle Scholar
  19. 19.
    Bège T, Chaumoître K, Léone M, Mancini J (2014) Blunt bowel and mesenteric injuries detected on CT scan: who is really eligible for surgery? Eur J Trauma Emerg Surg 40:75–81CrossRefPubMedGoogle Scholar
  20. 20.
    Bishop-Bartolomei K, Babineau TJ (2005) The role of computed tomography scanning in abdominal trauma: an update. Curr Surg 62:549CrossRefPubMedGoogle Scholar
  21. 21.
    Glatz JF, van der Vusse GJ (1996) Cellular fatty acid-binding proteins: their function and physiological significance. Prog Lipid Res 35:243–282CrossRefPubMedGoogle Scholar
  22. 22.
    Pelsers MMAL, Hermens WT, Glatz JFC (2005) Fatty acid-binding proteins as plasma markers of tissue injury. Clin Chim Acta 352:15–35CrossRefPubMedGoogle Scholar
  23. 23.
    Chan CPY, Wan TSM, Watkins KL et al (2004) Rapid analysis of fatty acid-binding proteins with immunosensors and immunotests for early monitoring of tissue injury. Biosens Bioelectron 20:2566–2580CrossRefPubMedGoogle Scholar
  24. 24.
    Flower DR (1996) The lipocalin protein family: structure and function. Biochem J 318(Pt 1):1–14CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Banaszak L, Winter N, Xu Z et al (1994) Lipid-binding proteins: a family of fatty acid and retinoid transport proteins. Adv Protein Chem 45:89–151CrossRefPubMedGoogle Scholar
  26. 26.
    Pelsers MMAL, Namiot Z, Kisielewski W et al (2003) Intestinal-type and liver-type fatty acid-binding protein in the intestine. Tissue distribution and clinical utility. Clin Biochem 36:529–535CrossRefPubMedGoogle Scholar
  27. 27.
    Edelson MB, Sonnino RE, Bagwell CE et al (1999) Plasma intestinal fatty acid binding protein in neonates with necrotizing enterocolitis: a pilot study. J Pediatr Surg 34:1453–1457CrossRefPubMedGoogle Scholar
  28. 28.
    Heida FH, Hulscher JBF, Schurink M et al (2014) Intestinal fatty acid-binding protein levels in Necrotizing Enterocolitis correlate with extent of necrotic bowel: results from a multicenter study. J Pediatr Surg 50:1115–1118CrossRefPubMedGoogle Scholar
  29. 29.
    Guthmann F, Börchers T, Wolfrum C et al (2002) Plasma concentration of intestinal- and liver-FABP in neonates suffering from necrotizing enterocolitis and in healthy preterm neonates. Mol Cell Biochem 239:227–234CrossRefPubMedGoogle Scholar
  30. 30.
    Kanda T, Tsukahara A, Ueki K et al (2011) Diagnosis of ischemic small bowel disease by measurement of serum intestinal fatty acid-binding protein in patients with acute abdomen: a multicenter, observer-blinded validation study. J Gastroenterol 46:492–500CrossRefPubMedGoogle Scholar
  31. 31.
    Kanda T, Fujii H, Fujita M et al (1995) Intestinal fatty acid binding protein is available for diagnosis of intestinal ischaemia: immunochemical analysis of two patients with ischaemic intestinal diseases. Gut 36:788–791CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Shi H, Wu B, Wan J et al (2015) The role of serum intestinal fatty acid binding protein levels and D-lactate levels in the diagnosis of acute intestinal ischemia. Clin Res Hepatol Gastroenterol 39:373–378CrossRefPubMedGoogle Scholar
  33. 33.
    Cronk DR, Houseworth TP, Cuadrado DG et al (2006) Intestinal fatty acid binding protein (I-FABP) for the detection of strangulated mechanical small bowel obstruction. Curr Surg 63:322–325CrossRefPubMedGoogle Scholar
  34. 34.
    Timmermans K, Sir Ö, Kox M et al (2014) Circulating iFABP Levels as a marker of intestinal damage in trauma patients. Shock 43:117–120CrossRefGoogle Scholar
  35. 35.
    Voth M, Holzberger S, Auner B et al (2014) I-FABP and L-FABP are early markers for abdominal injury with limited prognostic value for secondary organ failures in the post-traumatic course. Clin Chem Lab Med 53:771–780Google Scholar
  36. 36.
    Relja B, Szermutzky M, Henrich D et al (2010) Intestinal-FABP and liver-FABP: novel markers for severe abdominal injury. Acad Emerg Med 17:729–735CrossRefPubMedGoogle Scholar
  37. 37.
    von Elm E, Altman DG, Egger M et al (2014) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg 12:1495–1499CrossRefGoogle Scholar
  38. 38.
    Baker SP, O’Neill B, Haddon W, Long WB (1974) The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14:187–196CrossRefPubMedGoogle Scholar
  39. 39.
    Barrington I (1998) The Abbreviated Injury Scale 1990 revision—update 1998. Association for the Advancement of Automotive MedicineGoogle Scholar
  40. 40.
    Reinhart K, Brunkhorst FM, Bone HG et al (2006) Diagnose und Therapie der Sepsis. Intensivmed Notfallmed 43:369–384CrossRefGoogle Scholar
  41. 41.
    Vincent JL, Moreno R, Takala J et al (1996) The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. Intensive Care Med 22:707–710CrossRefPubMedGoogle Scholar
  42. 42.
    Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 270:2957–2963CrossRefPubMedGoogle Scholar
  43. 43.
    Bernard GR, Artigas A, Brigham KL (1994) The American-European consensus conference on ARDS definitions, mechanisms, relevant outcomes, and clinical trial coordination. Am J Respir Crit Care Med 149:818–824CrossRefPubMedGoogle Scholar
  44. 44.
    Dalhoff K, Abele M (2012) Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy. Pneumologie 66:707–765CrossRefPubMedGoogle Scholar
  45. 45.
    Watts DD, Fakhry SM (2003) Incidence of hollow viscus injury in blunt trauma: an analysis from 275,557 trauma admissions from the East multi-institutional trial. J Trauma 54:289–294CrossRefPubMedGoogle Scholar
  46. 46.
    Longo WE, Degutis LC, Baker CC (1989) Blunt hollow viscus injuries of the digestive tract: a poorly recognized phenomenon. Conn Med 53:451–454PubMedGoogle Scholar
  47. 47.
    Pal JD, Victorino GP (2002) Defining the role of computed tomography in blunt abdominal trauma: use in the hemodynamically stable patient with a depressed level of consciousness. Arch Surg 137:1029–1033CrossRefPubMedGoogle Scholar
  48. 48.
    Schellekens DHSM, Grootjans J, Dello SAWG et al (2013) Plasma intestinal fatty acid-binding protein levels correlate with morphologic epithelial intestinal damage in a human translational ischemia-reperfusion model. J Clin Gastroenterol 48:253–260CrossRefGoogle Scholar
  49. 49.
    Derikx JPM, Poeze M, van Bijnen AA et al (2007) Evidence for intestinal and liver epithelial cell injury in the early phase of sepsis. Shock 28:544–548PubMedGoogle Scholar
  50. 50.
    Ockner RK, Manning JA, Poppenhausen RB, Ho WK (1972) A binding protein for fatty acids in cytosol of intestinal mucosa, liver, myocardium, and other tissues. Science 177:56–58CrossRefPubMedGoogle Scholar
  51. 51.
    Derikx JPM, Vreugdenhil ACE, Van den Neucker AM et al (2009) A pilot study on the noninvasive evaluation of intestinal damage in celiac disease using I-FABP and L-FABP. J Clin Gastroenterol 43:727–733CrossRefPubMedGoogle Scholar
  52. 52.
    Uludağ M, Yetkin G, Citgez B et al (2009) Effects of additional intra-abdominal organ injuries in patients with penetrating small bowel trauma on morbidity and mortality. Ulus Travma Acil Cerrahi Derg 15:45–51PubMedGoogle Scholar
  53. 53.
    Matsumoto S, Sekine K, Funaoka H et al (2016) Clinical evaluation of “shock bowel” using intestinal fatty acid binding protein. Shock 47:100–106CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • M. Voth
    • 1
    Email author
  • M. Duchene
    • 1
  • B. Auner
    • 1
  • T. Lustenberger
    • 1
  • B. Relja
    • 1
  • I. Marzi
    • 1
  1. 1.Department of Trauma, Hand and Reconstructive SurgeryUniversity Hospital, Goethe University FrankfurtFrankfurt am MainGermany

Personalised recommendations