Pitfalls in gastrointestinal permeability measurement in ICU patients with multiple organ failure using differential sugar absorption.
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.


METHODS
Prospective observational cohort study.


METHODS
Eighteen-bed general ICU of a teaching hospital.


METHODS
Sixty-four ventilated patients admitted with MOF.


METHODS
GIP was assessed within 24 h using cellobiose (C), sucrose (S) and mannitol (M) absorption.


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.
Oudemans-van Straaten
Heleen M
HM
Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, P.O. Box 95500, 1090 HM Amsterdam, The Netherlands. h.m.oudemans-vanstraaten@olvg.nl
van der Voort
Peter J
PJ
Hoek
Frans J
FJ
Bosman
Rob J
RJ
van der Spoel
Johan I
JI
Zandstra
Durk F
DF
D018806:APACHE; D000284:Administration, Oral; D000368:Aged; D001803:Blood Transfusion; D002475:Cellobiose / Q000008:administration & dosage / Q000652:urine*; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007362:Intensive Care Units; D007408:Intestinal Absorption; D007413:Intestinal Mucosa / Q000378:metabolism* / Q000503:physiopathology; D007677:Kidney Function Tests; D008297:Male; D008353:Mannitol / Q000008:administration & dosage / Q000652:urine*; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000145:classification / Q000378:metabolism* / Q000628:therapy; D010539:Permeability; D015203:Reproducibility of Results; D013395:Sucrose / Q000008:administration & dosage / Q000652:urine*
D002475:Cellobiose; D008353:Mannitol; D013395:Sucrose