Rapid and Sustained Long-Term Decrease of Fecal Short-Chain Fatty Acids in Critically Ill Patients With Systemic Inflammatory Response Syndrome.
BACKGROUND
The gut is an important target organ for injury after severe insult. Short-chain fatty acids (SCFAs) are end-products of fermentation of dietary fibers by anaerobic microbiota. They are related to intestinal energy, motility, and transport and to protective effects against infection and inflammation. However, there are few clinical data on SCFAs in critically ill patients. We evaluated serial change in fecal SCFAs in patients with severe systemic inflammatory response syndrome (SIRS).


METHODS
This study included 140 intensive care unit (ICU) patients who fulfilled the criteria of SIRS and had a serum C-reactive protein level of >10 mg/dL. A fecal sample was used for quantitative measurement of fecal SCFA (butyrate, propionate, and acetate) concentrations by high-performance liquid chromatography. Fecal SCFAs were evaluated weekly for 6 weeks after admission. Data obtained from patients were compared with corresponding data from healthy volunteers.


RESULTS
SIRS resulted from infection in 78 patients, trauma in 30, burns in 12, and other causes in 20. Fecal concentrations of butyrate, propionate, and acetate in these patients decreased significantly compared with those in healthy volunteers and remained low throughout the 6 weeks of the patients' ICU stay. Fecal concentrations of SCFAs in the patients with gastrointestinal complications, including enteritis and dysmotility, were lower than those in the patients without gastrointestinal complications.


CONCLUSIONS
Concentrations of fecal SCFAs in patients with severe SIRS were significantly lower than those in healthy volunteers over a 6-week period. Maintenance of SCFAs may have therapeutic potential to prevent gastrointestinal complications in critically ill patients.
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan tomoki27@hp-emerg.med.osaka-u.ac.jp.
Tomoki
T
Yamada
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan.
Kentaro
K
Shimizu
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan.
Hiroshi
H
Ogura
Yakult Central Institute for Microbiological Research, Tokyo, Japan.
Takashi
T
Asahara
Yakult Central Institute for Microbiological Research, Tokyo, Japan.
Koji
K
Nomoto
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan.
Kazuma
K
Yamakawa
Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Osaka, Japan.
Toshimitsu
T
Hamasaki
Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan.
Yasutaka
Y
Nakahori
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan.
Mitsuo
M
Ohnishi
Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata-City, Osaka, Japan.
Yasuyuki
Y
Kuwagata
Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan.
Takeshi
T
Shimazu
D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D016022:Case-Control Studies; D002851:Chromatography, High Pressure Liquid; D003106:Colon / Q000378:metabolism* / Q000382:microbiology; D016638:Critical Illness; D004751:Enteritis / Q000150:complications; D005232:Fatty Acids, Volatile / Q000378:metabolism*; D005243:Feces / Q000737:chemistry*; D005260:Female; D005769:Gastrointestinal Motility; D006801:Humans; D007239:Infections / Q000150:complications; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000378:metabolism* / Q000382:microbiology
D005232:Fatty Acids, Volatile; D002097:C-Reactive Protein
critically ill; dysmotility; enteritis; gut microbiota; short-chain fatty acid; systemic inflammatory response syndrome