Gut barrier dysfunction in critically ill surgical patients with abdominal compartment syndrome.
OBJECTIVE
This study investigated the effects of intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) on gut barrier function in critically ill surgical patients.


METHODS
A prospective observational cohort study on patients with severe acute pancreatitis or abdominal sepsis admitted to an intensive care or high-dependency unit. Intra-abdominal pressure (IAP) and plasma levels of immunoglobulin G (IgG) and IgM antiendotoxin core antibodies (EndoCAb) and procalcitonin (ProCT) were measured serially.


RESULTS
Among 32 recruited patients, 24 (75%) and 8 patients (25%) developed IAH and ACS, respectively. The state of ACS was associated with significant reductions in plasma IgG EndoCAb (P = 0.015) and IgM EndoCAb (P = 0.016) and higher concentrations of plasma ProCT (P = 0.056) compared with absence of ACS. Resolution of IAH and ACS was associated with significant recovery of plasma IgG EndoCAb (P = 0.003 and P = 0.009, respectively) and IgM EndoCAb (P = 0.002 and P = 0.003, respectively) and reduction in plasma ProCT concentration (P = 0.049 and P = 0.019, respectively). Negative correlations were observed between IAP and plasma IgG EndoCAb (P = 0.003) and IgM EndoCAb (P = 0.002).


CONCLUSIONS
Intra-abdominal hypertension and ACS are associated with significantly higher endotoxin exposure and ProCT concentrations, suggestive of gut barrier dysfunction. Resolution of IAH and ACS is associated with evidence for recovery of gut barrier function.
Al-Bahrani
Ahmed Z
AZ
Department of Surgery, Manchester Royal Infirmary, Manchester, United Kingdom.
Darwish
Ammar
A
Hamza
Numan
N
Benson
Jonathon
J
Eddleston
Jane M
JM
Snider
Richard H
RH
Nylén
Eric S
ES
Becker
Kenneth L
KL
Barclay
George Robin
GR
Ammori
Basil J
BJ
D034841:Abdominal Cavity / Q000503:physiopathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002116:Calcitonin / Q000097:blood; D015740:Calcitonin Gene-Related Peptide; D015331:Cohort Studies; D003161:Compartment Syndromes / Q000378:metabolism* / Q000601:surgery*; D016638:Critical Illness; D005260:Female; D006801:Humans; D006973:Hypertension / Q000503:physiopathology; D007413:Intestinal Mucosa / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011498:Protein Precursors / Q000097:blood
C000606589:CALCA protein, human; D011498:Protein Precursors; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide