Importance of increased intestinal permeability after multiple injuries.
OBJECTIVE
To find out if there was a relationship between increased intestinal permeability and the development of multiple organ failure (MOF) after multiple injuries, we correlated the extent of injury and MOF with intestinal permeability on the second and fourth day after injury.


METHODS
Prospective open study.


METHODS
University hospital, Slovenia.


METHODS
29 multiply injured patients, injury severity score (ISS) over 25, admitted shocked.


METHODS
Intestinal permeability measured by giving lactulose and mannitol solution enterally on days 2 and 4.


METHODS
The lactulose: mannitol ratio calculated from the urinary portion of the probe molecules. ISS and the acute physiology and chronic health evaluation (APACHE II) calculated on admission.


RESULTS
The median lactulose: mannitol ratio for five volunteers was 0.014 (range 0.008-0.017) and that for 29 patients was 0.03 (0.01-0.1). On day 2 it was 0.03 (0.02-0.1), on day 4 0.02 (0.01-0.2). The ratio calculated on day 2 correlated with average and late MOF scores (r = 0.41 R2 = 0.1681, p <0.03 and r = 0.38, R2 = 0.1444, p <0.04) and that measured on day 4 correlated with overall, early, and late MOF scores (r = 0.47, R2 = 0.2209, p <0.01; r = 0.51, R2 = 0.2601, p <0.005; r = 0.39, R = 0.1512, p <0.04). No correlation was found between ISS, transport time, shock index, APACHE II, and days in intensive care.


CONCLUSIONS
Even if intestinal permeability is invariably increased after injury, it seems to have some predictive value for MOF in multiply injured patients because it correlates with its development.
Kompan
L
L
Central Intensive Therapy-CIT, Clinical Centre Ljubljana, Slovenia. LIDIJA.KOMPAN@MF.UNI-LJ.SI
Kompan
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D
D018806:APACHE; D000328:Adult; D005260:Female; D006801:Humans; D007408:Intestinal Absorption; D007792:Lactulose; D008297:Male; D008353:Mannitol; D009102:Multiple Organ Failure / Q000209:etiology / Q000503:physiopathology; D009104:Multiple Trauma / Q000503:physiopathology*; D010539:Permeability; D011237:Predictive Value of Tests; D011446:Prospective Studies
D008353:Mannitol; D007792:Lactulose