D2 | Abstract 09

Annual NUTRIM Symposium 18 November 2020

APPLIED SCIENCE

The detrimental course of acute intestinal ischemia: improving the diagnosis (TACTIC TRIAL).

A.A.M. Duivenvoorden1, M. Clarysse2, K. Geboers2, S. Vets2, M. Trzpis-Bremer6, A. Stam5, R. Geelkerken5, J.P.P.M. de Vries6, J.P.M. Derikx7,8, J.T. Blauw7, H.C.L.J. Buscher4, L.J. Ceulemans2, H.C. Dejong1,2,9 T. Lubbers2,9 K. Lenaerts1; on behalf of the Dutch Mesenteric Ischemia Study group

1 Department of Surgery, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
2 Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
3 Department of Abdominal Transplantation Surgery, UZ Leuven, Leuven, Belgium
4 Department of Vascular Surgery, Gelre Ziekenhuis, Apeldoorn, The Netherlands
5 Department of Vascular Surgery, Medische Spectrum Twente, Enschede, The Netherlands
6 Department of Surgery, University Medical Centre Groningen, Groningen, The Netherlands
7 Department of Intensive Care Medicine, Amsterdam UMC (location AMC), Amsterdam, The Netherlands
8 Department of Vascular Surgery, Amsterdam UMC (location VUMC), Amsterdam, The Netherlands
9 GROW - School for Oncology and Developmental Biology, Maastricht UMC+, Maastricht, The Netherlands
Rationale:
 Acute intestinal ischemia (AII) is a life-threatening condition with a short-term mortality ranging up to 80%. The diagnosis of AII has remained troublesome due to non-specific clinical presentation and symptoms. Early unambiguous diagnosis of AII is critical to prevent progression from reversible to irreversible intestinal injury, and henceforth decrease morbidity and improve survival.

Objective:
 This prospective international multicenter observational study aims to validate a panel of plasma biomarkers and to investigate volatile biomarkers in exhaled air that allow early and accurate identification of AII.

Methods:
This study aims to include 120 patients (60 patients with AII and 60 controls). Patients aged >18 years with clinical suspicion of AII who are admitted to the emergency department or intensive care unit of one of the participating centers are eligible for inclusion. Patient inclusion is based on: (1) clinical manifestation, (2) physical examination by the local physician, (3) laboratory measurements, and (4) physician’s consideration to perform a CT scan. Upon consent, patient’s characteristics will be collected, blood and exhaled air will be obtained. Plasma levels of I-FABP and VIL-1 (markers of mucosal damage) as well as SM22 (a marker of transmural damage) will be assessed by ELISA. Exhaled air will be analyzed with GC-MS-TOF to identify VOCs.

Results:
One patient has been included in the Maastricht UMC+. Start of inclusion at the other centers is expected in Q4 2020.

Conclusion:
 The primary objective is to validate the plasma biomarkers and determine if their proportion (I-FABP and VIL-1 versus SM22) can differentiate between reversible (mucosal) and irreversible (transmural) intestinal ischemic damage. The secondary objective is to identify an AII-specific VOC pattern in exhaled air. Based on these results, we expect to develop an algorithm for a rapid and unambiguous diagnosis of patients with AII, and for identification of those requiring emergency surgery.
OVERVIEW D2 ABSTRACTS OVERVIEW APPLIED SCIENCE

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