TY - JOUR
T1 - Pitfalls in gastrointestinal permeability measurement in ICU patients with multiple organ failure using differential sugar absorption
AU - Oudemans-van Straaten, Heleen M.
AU - Van der Voort, Peter H.
AU - Hoek, Frans J.
AU - Bosman, Rob J.
AU - Van Der Spoel, Johan I.
AU - Zandstra, Durk F.
PY - 2002/4/20
Y1 - 2002/4/20
N2 - Objective: To assess whether gastrointestinal permeability (GIP) at intensive care unit (ICU) admission, measured by differential sugar absorption, is related to severity of disease and multiple organ failure (MOF). Post hoc, to analyse the relation between the urinary sugar recovery and renal function. Design: Prospective observational cohort study. Setting: Eighteen-bed general ICU of a teaching hospital. Patients: Sixty-four ventilated patients admitted with MOF. Interventions: GIP was assessed within 24 h using cellobiose (C), sucrose (S) and mannitol (M) absorption. Measurements and results: Severity of disease: APACHE II and III, SAPS II and MPM II systems. Organ failure: SOFA, MODS and Goris score. The median urinary recovery of C was 0.147% (range 0.004-2.145%), of S 0.249% (0.001-3.656%) and of M 10.7% (0.6-270%). In 16 patients, M recovery was over 100% of the oral dose. They received red blood cell transfusion (RBC). In the non-transfused, the median cellobiose/mannitol (CM) ratio was 0.015 (0.0004-0.550). CM ratio was not related to severity of disease and inversely related to the SOFA score (r=-0.30, p=0.04). Post hoc regression analysis showed that recoveries of C, S and M were positively related to urinary volume. Recoveries of C and S, but not of M, were positively related to creatinine clearance. The CM ratio corrected for diuresis, but was inversely related to creatinine clearance. Conclusions: Differential C, S and M absorption testing is unreliable after RBC transfusion, since bank blood contains mannitol. The excretion of C and S, but not of M, is limited by renal dysfunction. Differential sugar absorption is not reliable to test GIP in MOF patients, since non-permeability related factors act as confounders.
AB - Objective: To assess whether gastrointestinal permeability (GIP) at intensive care unit (ICU) admission, measured by differential sugar absorption, is related to severity of disease and multiple organ failure (MOF). Post hoc, to analyse the relation between the urinary sugar recovery and renal function. Design: Prospective observational cohort study. Setting: Eighteen-bed general ICU of a teaching hospital. Patients: Sixty-four ventilated patients admitted with MOF. Interventions: GIP was assessed within 24 h using cellobiose (C), sucrose (S) and mannitol (M) absorption. Measurements and results: Severity of disease: APACHE II and III, SAPS II and MPM II systems. Organ failure: SOFA, MODS and Goris score. The median urinary recovery of C was 0.147% (range 0.004-2.145%), of S 0.249% (0.001-3.656%) and of M 10.7% (0.6-270%). In 16 patients, M recovery was over 100% of the oral dose. They received red blood cell transfusion (RBC). In the non-transfused, the median cellobiose/mannitol (CM) ratio was 0.015 (0.0004-0.550). CM ratio was not related to severity of disease and inversely related to the SOFA score (r=-0.30, p=0.04). Post hoc regression analysis showed that recoveries of C, S and M were positively related to urinary volume. Recoveries of C and S, but not of M, were positively related to creatinine clearance. The CM ratio corrected for diuresis, but was inversely related to creatinine clearance. Conclusions: Differential C, S and M absorption testing is unreliable after RBC transfusion, since bank blood contains mannitol. The excretion of C and S, but not of M, is limited by renal dysfunction. Differential sugar absorption is not reliable to test GIP in MOF patients, since non-permeability related factors act as confounders.
KW - Blood transfusion
KW - Critically ill
KW - Intestinal permeability
KW - Multiple organ dysfunction
KW - Renal dysfunction
KW - Sugar absorption
UR - http://www.scopus.com/inward/record.url?scp=0036215110&partnerID=8YFLogxK
U2 - 10.1007/s00134-001-1140-2
DO - 10.1007/s00134-001-1140-2
M3 - Article
C2 - 11907655
AN - SCOPUS:0036215110
VL - 28
SP - 130
EP - 138
JO - Intensive Care Medicine
JF - Intensive Care Medicine
SN - 0342-4642
IS - 2
ER -