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Trefoil factor 3 as a marker of gastrointestinal cell injury during sepsis
Ola Galal Ali Behairy1, Amira Osama Abd El-Gaffar2, Basma Galal Ali2
1Faculty of Medicine, Benha University, Benha, Egypt.
Insights
Trefoil factor 3 (TFF3) is elevated in pediatric sepsis, especially with gastrointestinal issues. Higher TFF3 levels indicate greater intestinal injury and predict poorer outcomes in critically ill children.
Area of Science:
- Biochemistry
- Pediatric Critical Care
- Gastroenterology
Background:
- Trefoil factor 3 (TFF3) is a peptide crucial for mucosal protection, epithelial repair, and maintaining gut barrier integrity.
- TFF3 has been explored as a potential biomarker for detecting intestinal injury.
Purpose of the Study:
- To assess trefoil factor 3 (TFF3) as a biomarker for gastrointestinal cellular injury in pediatric sepsis.
- To evaluate the association between TFF3 levels and sepsis severity, gastrointestinal involvement, and patient outcomes.
Main Methods:
- A case-control study involving 100 pediatric sepsis patients and 30 healthy controls.
- Measurement of serum TFF3 levels using ELISA, alongside standard laboratory tests and the Pediatric Logistic Organ Dysfunction (PELOD) score.
- Analysis of TFF3 levels in relation to gastrointestinal involvement, clinical outcomes, and causative pathogens.
Main Results:
- Serum TFF3 levels were significantly higher in children with sepsis, particularly those with gastrointestinal involvement, ileus, rectal bleeding, or melena.
- Elevated TFF3 levels correlated with increased sepsis severity, poor outcomes (non-survival), and specific bacterial infections (Klebsiella).
- TFF3 independently predicted sepsis and gastrointestinal dysfunction, with higher odds associated with elevated TFF3 levels in sepsis patients.
Conclusions:
- TFF3 serves as a valuable and objective biomarker for intestinal damage in pediatric sepsis patients within the PICU.
- Measuring TFF3 aids clinicians in anticipating, diagnosing, and managing gastrointestinal failure in critically ill children.
Abstract:
The purpose of this study is to evaluate trefoil factor 3 (TFF3) as a biomarker of gastrointestinal cellular injury in children with sepsis. This case-control study included 100 children admitted to the Pediatric Intensive Care Unit (PICU) with sepsis. They were divided into two groups according to gastrointestinal involvement, in addition to 30 age- and sex-matched healthy children who served as a control group. All participants underwent laboratory investigations, including complete blood count (CBC), liver, and kidney function tests. The Pediatric Logistic Organ Dysfunction (PELOD) score was applied to assess organ dysfunction severity, and TFF3 levels were measured using the enzyme-linked immunosorbent assay (ELISA) technique. TFF3 levels were markedly elevated in sepsis with gastrointestinal involvement compared to sepsis without gastrointestinal involvement and controls (P < 0.001). In these patients, levels were significantly higher in those with ileus, bleeding per rectum, and melena compared to those without. Non-survivors had higher TFF3 levels than survivors. Regarding blood culture results, patients with Klebsiella had the highest TFF3 levels compared to those with Staphylococcus aureus and those with no growth. In the multinomial logistic regression analysis using the control group as the reference category, TFF3 emerged as a significant predictor of sepsis outcomes. For patients with sepsis without gastrointestinal involvement, higher TFF3 levels were significantly associated with increased odds of sepsis (OR = 1.814, 95% CI 1.282-2.567, P = 0.001). Among patients with sepsis and gastrointestinal involvement, TFF3 demonstrated a more pronounced association (OR = 3.095, 95% CI 2.044-4.686, P < 0.001).
Conclusion:
TFF3 is a valuable tool in the PICU setting, providing an objective measure of intestinal damage and assisting clinicians in the anticipation, diagnosis, and management of gastrointestinal failure in vulnerable pediatric patients.
What Is Known:
• Trefoil factor 3 (TFF3) is a mucosal protective peptide involved in epithelial restitution and gut barrier integrity and has been investigated as a potential biomarker of intestinal injury.
What Is New:
• This study demonstrates that serum TFF3 levels are significantly elevated in pediatric sepsis, particularly in children with gastrointestinal involvement, ileus, rectal bleeding, or melena. • Elevated TFF3 levels were associated with poor outcomes and independently predicted sepsis severity and gastrointestinal dysfunction in critically ill children.
