Email this article 
Citrulline as a biomarker of short bowel syndrome in children
- Authors: Marakhouski K.Y.1, Svirsky A.A.1, Makhlin A.M.1, Shmeleva N.D.1, Kuvaeva Z.I.2, Korzuk E.B.2
-
Affiliations:
- Republican scientific and practical center of pediatric surgery
- Institute of physical and organic chemistry of the National Academy of Sciences of Belarus
- Issue: Vol 9, No 4 (2019)
- Pages: 35-42
- Section: Original Study Articles
- URL: https://rps-journal.ru/jour/article/view/618
- DOI: https://doi.org/10.30946/2219-4061-2019-9-4-35-42
- ID: 618
Cite item
Full Text
Abstract
Purpose. To determine the diagnostic significance of blood citrulline level when estimating the short bowel syndrome (SBS) in children under 5 years old. To determine the blood citrulline level in children of different age. Methods. The examined group (N=31) included children under 5 who underwent small or small and large intestine resection and developed (15 children) or not developed (16 children) clinical signs of SBS. The control group included children who underwent no surgery on the GIT and had no congenital malformations and clinical signs of enteropathy (N=42). To determine the level of citrulline, overpressured high performance liquid column chromatography was used. Statistical analysis of the results was done with MedCalc® version 18.11.3. Results. Mean level of blood citrulline is 28.9 µmol/l in the examined group (95% CI 23.2–34.6) and 30.5 µmol/l in the control group (95% CI 25.0–35.1). Reliable data of the ratio between blood level citrulline and age of the child were obtained both among operated and non-operated children. The odds ratio of determining citrulline in blood was below 24.4 µmol/l in development of SBS clinical picture and amounted to 4.08 р < 0,05. Additional use of ROC analysis confirms the presence of interrelation between citrulline level and absence or presence of SBS clinical signs with 100% specificity and 43% sensitivity. The area under curve (categorical variable showing whether SBS is present or lacking) is 0,746, р = 0,005. Conclusion. Determination of serum citrulline as a diagnostic marker of short bowel syndrome in children under 5 found low sensitivity but high specificity. Thus, blood citrulline index can be used as a biomarker to diagnose SBS, to describe the course of SBS in detail and determine the risk of severe forms of this pathology in children under 5.
Keywords
About the authors
K. Y. Marakhouski
Republican scientific and practical center of pediatric surgery
Author for correspondence.
Email: kmarakh@tut.by
ORCID iD: 0000-0002-4191-6053
Kirill Y. MARAKHOVSKI – Cand. Sci. (Med.), highest category endoscopist, Head of diagnostic division
Nezavisimosti ave., 64, Minsk, 220013
BelarusA. A. Svirsky
Republican scientific and practical center of pediatric surgery
Email: fake@neicon.ru
ORCID iD: 0000-0001-6323-6537
Alexander A. SVIRSKY – Cand. Sci. (Med.), associate professor, highest category pediatric surgeon, Deputy Director in medical treatment
Nezavisimosti ave., 64, Minsk, 220013
BelarusA. M. Makhlin
Republican scientific and practical center of pediatric surgery
Email: fake@neicon.ru
Alexander М. MAKHLIN – Highest category pediatric surgeon, surgical department No.3
Nezavisimosti ave., 64, Minsk, 220013
BelarusN. D. Shmeleva
Republican scientific and practical center of pediatric surgery
Email: fake@neicon.ru
ORCID iD: 0000-0002-8594-5278
Natalia D. SHMELEVA – Highest category epidemiologist, researcher, Department of Science
Nezavisimosti ave., 64, Minsk, 220013
BelarusZ. I. Kuvaeva
Institute of physical and organic chemistry of the National Academy of Sciences of Belarus
Email: fake@neicon.ru
Zoya I. KUVAEVA – Dr. Sci. (Med.), Professor, Head of Medicinal Substances Department
Surganova, 13, Minsk, 220072
BelarusE. B. Korzuk
Institute of physical and organic chemistry of the National Academy of Sciences of Belarus
Email: fake@neicon.ru
Ekaterina B. KORZUK – Junior research assistant, Medicinal Substances Department
Surganova, 13, Minsk, 220072
BelarusReferences
- Cole C. R., Hansen N. I., Higgins R. D., Zeigler T. R., Stoll B. J., and for the Eunice Kennedy Shriver National Institute of Child health and Human Development neonatal research network. Very low birth weight preterm infants with surgical short bowel syndrome: Incidence, morbidity and mortality, and growth outcomes at 18 to 22 months. Pediatrics 2008; 122(3):e573–82 doi: 10.1542/peds.2007–3449
- Аверьянова Ю. В., Вессель Л. М., Ерпулёва Ю. В., Николаев В. В., Степанов А. Э., Чубарова А. И., Щукин В. В., Хасанов Р. Р. Федеральные клинические рекомендации «лечение детей с синдромом короткой кишки». Российский вестник детской хирургии, анестезиологии и реаниматологии. 2014;4(4):92–108
- Хасанов Р. Р., Гумеров А. А., Вессель Л. М. Причины развития синдрома короткой кишки. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2017;7(3):8–12
- Сухотник И. Г. Синдром короткой кишки у детей. Российский вестник детской хирургии, анестезиологии и реаниматологии. 2017;7(3):98–115
- Struijs M. C., Diamond I.R, de Silva N, Wales P. W. Establishing norms for intestinal length in children. J. Pediatr. Surgery 2009;44(5):933–8 doi: 10.1016/j.jpedsurg.2009.01.031
- Wilmore D. W. Factor correlation with successful outcome following extensive intestinal resection in newborn infants. J. Pediatr. 1972;80(1):88–95 doi: 10.1016/s0022–3476(72)80459–1
- Casey L., Lee K. H., Rosychuk R., Turner J. and Huynh H. Q. 10-years review of pediatric intestinal failure: Clinical factors associated with outcome. Nutr. Clin. Pract. 2008;23(4):436–42 doi: 10.1177/0884533608321213
- Quiros-Tejeira R.E., Ament M. E., Reyen L., Herzog F., Merjianian M., Olivares-Serrano N. and Vargas J. H. Long-term parenteral nutritional support and intestinal adaptation in children with short bowel syndrome. A 25-years experience. J. Pediatr. 2004;145(2):157–63 doi: 10.1016/j.jpeds.2004.02.030
- Spenncer A. U., Neaga A., West B., Safran J., Brown P., Btaiche I., Kuzma-O`Reilly B. and Teitelbaum D. H. Pediatric short bowel syndrome: Redefining predictors of success. Ann. Surg. 2005;242(3):403–9; discussion 409–412. doi: 10.1097/01.sla.0000179647.24046.03
- Duggan C. P. Clinical management of intestinal failure. Duggan C. P., Gura K., Jaksic T. CRC Press. Includes bibliographical references and index. ISBN978–1–4398–1390–4 2011.p.524
- Windmueller H. G. and Spaeth A. E. Source and fate of circulating citrulline. Am. J. Physiol Endocrinol. Metab.1981;241: e473-e480 doi: 10.1152/ajpendo.1981.241.6.E473
- Crenn P., Messing B. and Cynober L. Citrulline as a biomarker of intestinal failure due to enterocyte mass reduction. Clin. Nutr. 2008;27:328–39 doi: 10.1016/j.clnu.2008.02.005
- Fragkos K. S., Forbes A. Citrulline as a marker of intestinal function and absorption in clinical settings: a systematic review and meta-analysis. United European Gastroenterology Journal 2018;6(2):181–91 doi: 10.1177/2050640617737632
- Мараховский Ю. Х., Горгун Ю. В. Способ оценки состояния слизистой оболочки тонкого кишечника по биомаркерам. Инновационные технологии в медицине. 2014;1(2):68–83
- Marakhouski K., Pauk I., Kletski S., Kuvaeva Z. Сan blood citrulline level in infants, with gluten independent enteropathy, screening test for small intestine mucosa atrophy. October 2014 Conference: UEGW 2014 Volume: UEG Journal October 2014: Volume 2: Supplement 1 P1130 ISSN2050–6406 (Print): ISSN2050–6414 (Online)
- Rhoads J. M., Plunkett E., Galanko J., Lichtman S., Taylor L., Maynor A., Weiner T., Freeman K., Guarisco J. L., Wu G. Y. Serum citrullin levels correlate with enteral tolerance and bowel length in infants with short bowel syndrome. J. Pediatr. 2005;146(4):542–7 doi: 10.1016/j.jpeds.2004.12.027
- Goossens L., Bouvry M., Vanhaesebrouck P., Wuyts B., Van Maele G., Robberecht E. Citrulline levels in a paediatric age group: does measurement on dried blood spots have additional value? Clin. Chim. Acta. Mar 18, 2011;412(7–8):661–4 doi: 10.1016/j.cca.2010.11.021
Supplementary files
