Exocrine pancreatic dysfunction in sepsis.
BACKGROUND
Sepsis in critical illness is associated with the progressive failure of multiple organs. This study aims to establish a correlation between the severity of sepsis and exocrine pancreatic dysfunction.


METHODS
In a prospective cohort study pancreatic exocrine function was tested by means of a secretin-cholecystokinin test in 21 critically ill, mechanically ventilated patients with sepsis according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference Committee (ACCP/SCCM): 11 patients with shock and 10 patients without shock. Data were compared with seven healthy controls.


RESULTS
The volume of duodenal fluid was not statistically different in the three groups. Sepsis patients without shock had significantly reduced content of amylase and chymotrypsin in duodenal juice compared with healthy controls (P < 0.01). Secretion of amylase, chymotrypsin, trypsin (P < 0.01 each) and bicarbonate in duodenal fluid (P < 0.05) was impaired in the septic shock patients when compared with the healthy controls. The content of trypsin was different between sepsis patients and septic shock patients (P < 0.05). Spearman correlation analysis was significant between the amylase secretion and the APACHE III and SOFA scores (P < 0.01). The SOFA score was also related to secretion of trypsin (P < 0.05). In patients on pressor therapy, use of norepinephrine was associated with a significant decrease in bicarbonate secretion (P < 0.05).


CONCLUSIONS
Sepsis is associated with secretory pancreatic dysfunction that is worse in septic shock than in sepsis without shock. Impaired exocrine function was significantly correlated to the APACHE III and SOFA scores.
Tribl
B
B
Department of Internal Medicine IV, Division of Gastroenterology and Hepatology, University of Vienna, Vienna, Austria. barbara.tribl@akh-wien.ac.at
Sibbald
W J
WJ
Vogelsang
H
H
Spitzauer
S
S
Gangl
A
A
Madl
C
C
D000328:Adult; D000368:Aged; D002766:Cholecystokinin / Q000378:metabolism; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000378:metabolism*; D010182:Pancreatic Diseases / Q000150:complications / Q000378:metabolism*; D011446:Prospective Studies; D012633:Secretin / Q000378:metabolism; D018805:Sepsis / Q000209:etiology / Q000378:metabolism*; D012772:Shock, Septic / Q000209:etiology / Q000378:metabolism*
D012633:Secretin; D002766:Cholecystokinin