Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial.

Purpose: The effects of the route of nutrition on the gut mucosa of patients with shock are unclear. Plasma citrulline concentration is a marker of enterocyte mass, and plasma intestinal fatty acid binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to study the effect of the route of nutrition on plasma citrulline concentration measured at day 3 of nutrition.
Materials and Methods: Ancillary study of the NUTRIREA-2 trial. Ventilated adults with shock were randomly assigned to receive enteral or parenteral nutrition. Enterocyte biomarkers were measured at baseline, day 3, and day 8 of nutrition.
Result: A total of 165 patients from 13 French ICUs were included in the study: 85 patients in the enteral group and 80 patients in the parenteral group. At baseline, plasma citrulline was low without difference between groups (12.2 µmol L ^-1 vs 13.3 µmol L ^-1 ). At day 3, plasma citrulline concentration was higher in the enteral group than in the parenteral group (18.7 µmol L ^-1 vs 15.3 µmol L ^-1 , p = 0.01). Plasma I-FABP concentration was increased at baseline, without difference between groups (245 pg mL ^-1 vs 244 pg mL ^-1 ). Plasma I-FABP concentration was higher in the enteral group than in the parenteral group at day 3 and day 8 (158 pg mL ^-1 vs 50 pg mL ^-1 , p = 0.005 and 225 pg mL ^-1 vs 50 pg mL ^-1 , p = 0.03).
Conclusion: Plasma citrulline concentration was higher after 3 days of enteral nutrition than after 3 days of parenteral nutrition. This result raises the question of the possibility that enteral nutrition is associated with a more rapid restoration of enterocyte mass than parenteral nutrition.