PLASMA CITRULLINE AS A CLINICAL BIOMARKER OF DEPENDENCE ON PARENTERAL NUTRITION

In this retrospective-observational study we investigated on the role of p-citrulline as a possible marker of dependence on PN with a cut-off of 20 µmol/l. Fasting p-citrulline was analyzed with Ion-Exchange HPLC in IICB patients enrolled in SC Dietetics and Clinical Nutrition. Inclusion criteria: small bowel length Data reported were expressed as median (range) or mean (± ds) as appropriate. Correlations and a multivariate analysis were performed between p-cit and age, intestinal features, eGFR and PN nutrition. Twenty-seven 21- 82 years old (14M/13F) patients participated in this study; small bowel length was 60 cm (2-200); percent of colon: 50% (0-100); ileo-cecal valve 1 yes/26 no; diagnosis: 11 pts mesenteric vasculopathy, 6 pts surgical outcome, 7 pts IBD, 3 pts other diseases. HPN duration 712 days (167-7239); PN energy: 69,6 %BEE (5-120); PN volume 1900 ml (1000-3600); BMI 21,8 kg/m2 (16-32,1); eGFR 78 ml/min/1,73m2 (43-141); p-cit (reference range 29.1-42.8 µmol/l): 24,5 µmol/l (5-49,6); 9 pts 29,1 µmol/l: 33,3 % of pts was below literature cut-off. Significant correlations were found for: age, r=0,418 (p ≤ 0,05); small bowel length, r = 0,48 (p ≤ 0,01); eGFR, r= −0,4 (p ≤ 0,05); PN-energy, r = −0,49 (p ≤ 0,01); PN volume, r= −0,48 (p≤0,01). The multivariate analysis confirms the correlation with the same variables (F = 4,26; P = 0,0079). The significant correlation between p-cit and small bowel length confirmed p-cit as a possible indicator of spontaneous bowel adaptation but different cut-off for PN dependence could be assessed beacause the 66,6% of pts in HPN had values > 20 µmol/l.