Importance of increased intestinal permeability after multiple injuries.

OBJECTIVE

To find out if there was a relationship between increased intestinal permeability and the development of multiple organ failure (MOF) after multiple injuries, we correlated the extent of injury and MOF with intestinal permeability on the second and fourth day after injury.

DESIGN

Prospective open study.

SETTING

University hospital, Slovenia.

PATIENTS

29 multiply injured patients, injury severity score (ISS) over 25, admitted shocked.

INTERVENTION

Intestinal permeability measured by giving lactulose and mannitol solution enterally on days 2 and 4.

MAIN OUTCOME MEASURES

The lactulose: mannitol ratio calculated from the urinary portion of the probe molecules. ISS and the acute physiology and chronic health evaluation (APACHE II) calculated on admission.

RESULTS

The median lactulose: mannitol ratio for five volunteers was 0.014 (range 0.008-0.017) and that for 29 patients was 0.03 (0.01-0.1). On day 2 it was 0.03 (0.02-0.1), on day 4 0.02 (0.01-0.2). The ratio calculated on day 2 correlated with average and late MOF scores (r = 0.41 R2 = 0.1681, p <0.03 and r = 0.38, R2 = 0.1444, p <0.04) and that measured on day 4 correlated with overall, early, and late MOF scores (r = 0.47, R2 = 0.2209, p <0.01; r = 0.51, R2 = 0.2601, p <0.005; r = 0.39, R = 0.1512, p <0.04). No correlation was found between ISS, transport time, shock index, APACHE II, and days in intensive care.

CONCLUSIONS

Even if intestinal permeability is invariably increased after injury, it seems to have some predictive value for MOF in multiply injured patients because it correlates with its development.