Article révisé par les pairs
Résumé : 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.

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