title: Histological damage of colonic epithelium is associated with clinical severity and outcome in colectomized critically Ill patients.
abstract: BACKGROUND
  Severe intestinal mucosal damage and organ failure has been associated in experimental models. Our purpose was to determine whether there is any association between histopathological findings and postoperative mortality among ICU patients undergoing emergency colectomies for various illnesses.
  
  
  METHODS
  In a retrospective case control study, total colectomy specimens from 50 patients in a mixed ICU were analysed: 18 had sepsis, 11 vascular operations, and 21 Clostridium difficile colitis. Overall thickness, the width of epithelial defects, and presence of cryptal damage were assessed. Extent of necrosis and amount of neutrophils were separately evaluated in the layers of the colonic wall. Clinical features, including sequential organ failure assessment (SOFA) scores and survival, were registered.
  
  
  RESULTS
  The histopathological findings for the three clinical entities were similar, except for the abundance of characteristic pseudomembranes in the Clostridium group. Mucosal height (maximum) showed a negative correlation with SOFA score on admission (ρ = -0.296, P = 0.037), and with preoperative blood lactate level (ρ = -0.316; P = 0.027). The nonsurvivors had wider enterocyte defects (60 vs. 40.8, P = 0.002) and more severe crypt damage (61 vs. 27 %; P = 0.024) than the survivors.
  
  
  CONCLUSIONS
  The histopathological damage involves all layers of the colon wall among ICU patients being largely similar in sepsis, C. difficile infection, and ischemia after vascular operations. Mucosal epithelial damage is associated with clinical severity of the illness and mortality.
authors: Division of Intensive Care Medicine, Department of Anaesthesiology, Oulu University Hospital and Medical Research Center, PO Box 21, 90029, Oulu, Finland, seija.sipola@ppshp.fi.
authors: S
authors: S
authors: Sipola
authors: T I
authors: TI
authors: Ala-Kokko
authors: J J
authors: JJ
authors: Laurila
authors: M
authors: M
authors: Vakkala
authors: P
authors: P
authors: Ohtonen
authors: J
authors: J
authors: Saarnio
authors: T J
authors: TJ
authors: Karttunen
authors: H
authors: H
authors: Syrjälä
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003082:Colectomy; D003106:Colon / Q000473:pathology*; D016638:Critical Illness; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome