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Relationship Between Plasma Citrulline Concentration And Progression To Parenteral Nutrition Independence In Children With Short Bowel Syndrome

Shimae Fitzgibbons, Y. Avery Ching, Clarissa Valim, Julie Iglesias, Christopher Duggan, Tom Jaksic
Children’s Hospital; Boston, MA


PURPOSE OF STUDY
While bowel length is an important prognostic variable used in the management of children with short bowel syndrome (SBS), reliable measurements can be difficult to obtain. Plasma citrulline concentration (CIT) has been proposed as a surrogate marker for bowel length and function. We sought to evaluate the relationship between CIT and parenteral nutrition (PN) independence in children with SBS.

METHODS USED:
Retrospective chart review of all patients seen in a multidisciplinary pediatric intestinal rehabilitation clinic with a recorded CIT between January 2005 and December 2007 (n=27).

SUMMARY OF RESULTS:
Median age at time of CIT determination was 2.4 years. Diagnoses included necrotizing enterocolitis (26%), gastroschisis (22%), and intestinal atresias (19%). CIT correlated well with bowel length (R=0.73, p<0.0001) and was a strong predictor of PN independence (p-Wilcoxon=0.002, area under the ROC curve=0.88, 95% CI=0.75-1.00). The optimal CIT cutoff-point distinguishing patients who reached PN independence was 15 µmol/L (sensitivity=89%, specificity=78%). No patients with a CIT below 12 µmol/L reached PN independence in our population.

CONCLUSIONS:
Plasma citrulline concentration is a strong predictor of PN independence in children with SBS, and correlates well with a patient’s recorded bowel length. A cutoff CIT level of 15 µmol/L may serve as a prognostic measure in counseling patients regarding the likelihood of future PN independence.

 

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