Association between Trefoil Factor 3 and Gastrointestinal Failure in Critically Ill Children

Qing-Li Zhang, Xiao-Nan Xu, Anthony Otley, Noni E MacDonald, Andrew S Day

Abstract


AIM: While gut dysfunction has been proposed as an important factor in multiorgan dysfunction syndrome (MODS), there are few objective measures of gut failure. This study aimed to ascertain the key features of intestinal failure in MODS and to determine if serum trefoil factor 3 (TFF3) correlated with intestinal failure in patients with MODS. METHODS: A retrospective assessment of children admitted to a pediatric intensive care unit (PICU) was undertaken to characterize key features of MODS with intestinal failure. A second cohort of children with MODS was enrolled prospectively with serial measurement of serum TFF3 from admission until day 5. TFF3 was also measured in 30 healthy infants. RESULTS: Intestinal failure was associated with higher mortality, longer PICU stay and greater acidosis or hypoxia in the retrospective cohort. In the prospective study, baseline serum TFF3 was higher in the children with MODS and intestinal failure than children with MODS without intestinal failure or healthy control children (13.2±3.1 ug/mL vs 1.5±0.5 ug/mL vs 1.8±0.4 ug/mL: p<0.01). The mean TFF3 in the children without intestinal failure did not increase over time, while levels in children with MODS and intestinal failure increased progressively (p<0.01). Elevated TFF3 was associated with higher mortality (71 % vs 32%: p<0.01). CONCLUSION: Serum TFF3 was elevated only in children with MODS and intestinal failure and correlated with mortality in this group. Measurement of TFF3 in children with MODS gives an assessment of intestinal function and may have a prognostic role in this setting.

Keywords


Trefoil factor 3; Multiorgan dysfunction syndrome; Gastrointestinal failure; Pediatric

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