L-FABP and NGAL are novel biomarkers for detection of abdominal injury and hemorrhagic shock

  • M. Voth
    Corresponding author at: Department of Trauma, Hand and Reconstructive Surgery, University Hospital Goethe University, Theodor-Stern-Kai 7, D-60590 Frankfurt / Main, Germany.
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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  • R. Verboket
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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  • D. Henrich
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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  • I. Marzi
    Department of Trauma, Hand and Reconstructive Surgery, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
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Published:January 02, 2023DOI:


      • L-FABP is a novel biomarker for the early detection of abdominal injury and of hemorrhagic shock.
      • L-FABP is specific in the detection of an injury of the kidney and liver.
      • NGAL is a novel biomarker for the detection of abdominal injury and hemorrhagic shock.
      • NGAL failed to be specific in the detection of an injury of the liver and/or the kidney.



      Delayed diagnosis of abdominal injuries and hemorrhagic shock leads to secondary complications and high late mortality in severely traumatized patients. The liver fatty acid-binding protein (L-FABP) is expressed in intestine, liver and kidney; the neutrophil gelatinase-associated lipocalin (NGAL) in colon and kidney. We hypothesized that l-FABP is an early biomarker for abdominal injury and hemorrhagic shock and that l-FABP and NGAL are specific markers for detection of liver and/or kidney injuries.

      Patients and Methods

      Traumatized patients with an age ≥18 years and an abdominal injury (AISabd≥2), independently from Injury Severity Score (ISS), were prospectively included from 04/2018 to 05/2021. 68 patients had an abdominal injury (“Abd”) and 10 patients had an abdominal injury with hemorrhagic shock (“HS Abd”). 41 patients without abdominal injury and hemorrhagic shock but with an ISS ≥ 25 (“noAbd”) were included as control group. Four abdominal subgroups with isolated organ injuries were defined. Plasma l-FABP and NGAL levels were measured at admission (ER) and up to two days post-trauma.


      All patient groups had a median ISS≥25. In ER, median l-FABP levels were significantly higher in “HS Abd” group (1209.2 ng/ml [IQR=575.2–1780.3]) compared to “noAbd” group (36.4 ng/ml [IQR=14.8–88.5]), and to “Abd” group (41.4 ng/ml [IQR=18.0–235.5]), p<0.001. In matched-pair-analysis l-FABP levels in the group “Abd” were significantly higher (108.3 ng/ml [IQR=31.4–540.9]) compared to “noAbd” (26.4 ng/ml [IQR=15.5–88.8]), p = 0.0016. l-FABP correlated significantly with clinical parameters of hemorrhagic shock; the optimal cut-off level of l-FABP for detection was 334.3 ng/ml (sensitivity: 90%, specificity: 78%). Median l-FABP-levels were significantly higher in patients with isolated liver or kidney injuries and correlated significantly with AST, ALT and creatinine value. Median NGAL levels in the ER were significantly higher in “HS Abd” group (115.9 ng/ml [IQR=90.6–163.8]) compared to “noAbd” group (58.5 ng/ml [IQR=41.0–89.6],p<0.001) and “Abd” group (70.5 ng/ml [IQR=53.3–115.5], p<0.05). The group “Abd” showed significant higher median NGAL levels compared to “noAbd”, p = 0.019. NGAL levels correlated significantly with clinical parameters of hemorrhagic shock.


      :L-FABP and NGAL are novel biomarkers for detection of abdominal trauma and hemorrhagic shock. l-FABP may be a useful and promising parameter in diagnosis of liver and kidney injuries, NGAL failed to achieve the same.



      Abd (Patients with abdominal injury), AIS (Abbreviated Injury Scale), ALT (aspartate transferase), AST (alanine transferase), AUC (Area under the curve), CI (Confidence interval), ER (Emergency Room), FFP (Fresh frozen plasma), H-FABP (Heart-type fatty acid binding protein), Hb (Hemoglobin), HS Abd (Patients with hemorrhagic shock and abdominal injury), Intestinal (isolated injuries of the intestine), ICU (Intensive care unit), IQR (Interquartile Range), IL-6 (interleukin-6), INR (International normalized ratio), ISS (Injury Severity Score), Kidney (isolated injuries of the kidney), L-FABP (Liver fatty acid-binding protein), Liver (isolated injuries of the liver), MAP (Mean arterial pressure), MODS (Multiple organ dysfunction syndrome), NGAL (neutrophil gelatinase-associated lipocalin), noAbd (Patients with hemorrhagic shock and without abdominal injury), PLT (Platelets), NPV (Negative predictive value), PPV (Positive predictive value), PRBC (Packed red blood cells), PTT (Partial thromboplastin time), ROC (Receiver operator characteristic curves), SBP (Systolic blood pressure), SI (Shock index), SIRS (Systemic inflammatory distress syndrome), Spleen (isolated injuries of the spleen)
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