Catecholamine use is associated with enterocyte damage in critically ill patients

Area of Science:

• Critical Care Medicine
• Gastroenterology
• Pharmacology

Background:

• Small bowel damage is common but often overlooked in critically ill patients experiencing shock.
• High doses of catecholamines, used to manage shock, may negatively impact blood flow to the intestines.
• Plasma intestinal fatty acid-binding protein (I-FABP) and citrulline are biomarkers for enterocyte damage and function, respectively.

Purpose of the Study:

• To investigate the association between catecholamine use and dose with enterocyte damage in critically ill patients.
• To determine if high catecholamine doses contribute to intestinal injury.

Main Methods:

• Prospective observational study in a university teaching hospital.
• Included critically ill patients requiring epinephrine/norepinephrine and controls not receiving catecholamines.
• Measured plasma I-FABP, citrulline, abdominal perfusion pressure, and categorized catecholamine doses at ICU admission.

Main Results:

• Patients receiving catecholamines had significantly higher plasma I-FABP levels compared to controls.
• A catecholamine dose of ≥ 0.48 γ/kg/min was linked to elevated I-FABP concentrations.
• High Sepsis-related Organ Failure Assessment scores and elevated I-FABP were independent predictors of 28-day mortality.

Conclusions:

• Catecholamine administration is associated with increased enterocyte damage (indicated by I-FABP) in critically ill patients.
• Higher catecholamine doses (≥ 0.48 γ/kg/min) correlate with greater enterocyte damage.
• Enterocyte damage may reflect shock severity, with a potential direct adverse effect of catecholamines.