Mesure de la fonctionnalité intestinale en réanimation par la détermination de la citrullinémie

Acute intestinal failure is an important cause of multiorgan failure in ICU but is difficult to evaluate. Circulating citrulline emerged as a candidate for evaluation of intestinal function. Amino acid synthetized by enterocytes of intestinal mucosal, citrulline is not included in proteins or nutrition products and is a precursor for production of arginine by kidney. Plasma citrulline is, in clinical situation, an established biomarker of enterocyte functional metabolic mass in children and in adult patients due to its high relation to functional small bowel remnant length in intestinal diseases. Plasma citrulline concentration less than 10-20 μmol/L can give an objective threshold for nutrition parenteral use in case of intestinal failure due to enterocyte abnormalities or lack. It was recently shown that severe hypocitrullinemia (< 10 μmol/L) during ICU (H24), probably due to a decrease of intestinal production by ischemia, is an independent factor of mortality, adding to SOFA, which does not take into account intestinal function.