Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans
- PMID: 11113071
- DOI: 10.1053/gast.2000.20227
Postabsorptive plasma citrulline concentration is a marker of absorptive enterocyte mass and intestinal failure in humans
Abstract
Background & aims: No blood marker assessing the functional absorptive bowel length has been identified. Plasma citrulline, a nonprotein amino acid produced by intestinal mucosa, is one candidate. We tested this hypothesis in adult patients with the short-bowel syndrome, whose condition can lead to intestinal failure.
Methods: In 57 patients, after a minimal follow-up of 2 years subsequent to final digestive circuit modification, postabsorptive citrulline concentration was measured and parenteral nutrition dependence was used to define permanent (n = 37) and transient (n = 20) intestinal failure. Absorptive function, studied over a 3-day period, was evaluated by net digestive absorption for protein and fat (n = 51). Relations between quantitative values were assessed by linear regression analysis and cutoff citrulline threshold, for a diagnosis of intestinal failure by linear discriminant analysis. Cox model was used to compare citrulline threshold and anatomic variables of the short bowel as indicators of transient as opposed to permanent intestinal failure.
Results: In patients with short-bowel syndrome, citrulline levels were lower than in controls (n = 51): 20 +/- 13 vs. 40 +/- 10 micromol/L (mean +/- SD), respectively (P < 0.001). After multivariate analysis, citrullinemia was correlated to small bowel length (P < 0.0001, r = 0.86) and to net digestive absorption of fat, but to neither body mass index nor creatinine clearance. A 20-micromol/L threshold citrullinemia, (1) classified short bowel patients with permanent intestinal failure with high sensitivity (92%), specificity (90%), positive predictive value (95%), and negative value (86%); and (2) was a more reliable indicator (odds ratio, 20.0; 95% confidence interval, 1.9-206.1) than anatomic variables (odds ratio, 2.9; 95% confidence interval, 0. 5-15.8) to separate transient as opposed to permanent intestinal failure.
Conclusions: In patients with short-bowel syndrome, postabsorptive plasma citrulline concentration is a marker of functional absorptive bowel length and, past the 2-year adaptive period, a powerful independent indicator allowing distinction of transient from permanent intestinal failure.
Similar articles
-
Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction.Clin Nutr. 2008 Jun;27(3):328-39. doi: 10.1016/j.clnu.2008.02.005. Epub 2008 Apr 28. Clin Nutr. 2008. PMID: 18440672 Review.
-
Plasma citrulline: A marker of enterocyte mass in villous atrophy-associated small bowel disease.Gastroenterology. 2003 May;124(5):1210-9. doi: 10.1016/s0016-5085(03)00170-7. Gastroenterology. 2003. PMID: 12730862
-
Serum citrulline is a simple quantitative marker for small intestinal enterocytes mass and absorption function in short bowel patients.J Surg Res. 2005 Aug;127(2):177-82. doi: 10.1016/j.jss.2005.04.004. J Surg Res. 2005. PMID: 15921697
-
Citrulline blood levels as indicators of residual intestinal absorption in patients with short bowel syndrome.Ann Nutr Metab. 2008;53(2):137-42. doi: 10.1159/000170888. Epub 2008 Nov 10. Ann Nutr Metab. 2008. PMID: 18997462
-
Citrulline and the gut.Curr Opin Clin Nutr Metab Care. 2007 Sep;10(5):620-6. doi: 10.1097/MCO.0b013e32829fb38d. Curr Opin Clin Nutr Metab Care. 2007. PMID: 17693747 Review.
Cited by
-
Citrulline: just a biomarker or a conditionally essential amino acid and a pharmaconutrient in critically ill patients?Crit Care. 2013 Mar 11;17(2):122. doi: 10.1186/cc12534. Crit Care. 2013. PMID: 23509945 Free PMC article.
-
Antenatal Growth, Gestational Age, Birth, Enteral Feeding, and Blood Citrulline Levels in Very Low Birth Weight Infants.Nutrients. 2024 Feb 7;16(4):476. doi: 10.3390/nu16040476. Nutrients. 2024. PMID: 38398801 Free PMC article.
-
Chyme Reinfusion Restores the Regulatory Bile Salt-FGF19 Axis in Patients With Intestinal Failure.Hepatology. 2021 Nov;74(5):2670-2683. doi: 10.1002/hep.32017. Epub 2021 Aug 26. Hepatology. 2021. PMID: 34133768 Free PMC article. Clinical Trial.
-
Proteins and amino acids are fundamental to optimal nutrition support in critically ill patients.Crit Care. 2014 Nov 17;18(6):591. doi: 10.1186/s13054-014-0591-0. Crit Care. 2014. PMID: 25565377 Free PMC article. Review.
-
Plasma citrulline is not a biomarker for intestinal adaptation in short bowel syndrome, studied in piglets: a model for human neonates.Pediatr Surg Int. 2019 Jun;35(6):657-663. doi: 10.1007/s00383-019-04475-4. Epub 2019 Apr 1. Pediatr Surg Int. 2019. PMID: 30937511
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical
Miscellaneous