肠上皮细胞损伤与感染性休克患者液体平衡的关系：一项前瞻性观察研究的事后探索性分析。

Association between enterocyte injury and fluid balance in patients with septic shock: a post hoc exploratory analysis of a prospective observational study.

机构信息

Department of Anesthesiology and Intensive Care Medicine, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.

Department of Research and Development, SB Bioscience Co. Ltd., 3-47 Higashi-Tsukaguchi-cho, 2-chome, Amagasaki, Hyogo, 661-0011, Japan.

出版信息

BMC Anesthesiol. 2021 Nov 23;21(1):293. doi: 10.1186/s12871-021-01515-2.

DOI:10.1186/s12871-021-01515-2

PMID:34814831

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8609797/

Abstract

BACKGROUND

The required fluid volume differs among patients with septic shock. Enterocyte injury caused by shock may increase the need for fluid by triggering a systematic inflammatory response or an ischemia-reperfusion injury in the presence of intestinal ischemia/necrosis. This study aimed to evaluate the association between enterocyte injury and positive fluid balance in patients with septic shock.

METHODS

This study was a post hoc exploratory analysis of a prospective observational study that assessed the association between serum intestinal fatty acid-binding protein, a biomarker of enterocyte injury, and mortality in patients with septic shock. Intestinal fatty acid-binding protein levels were recorded on intensive care unit admission, and fluid balance was monitored from intensive care unit admission to Day 7. The association between intestinal fatty acid-binding protein levels at admission and the infusion balance during the early period after intensive care unit admission was evaluated. Multiple linear regression analysis, with adjustments for severity score and renal function, was performed.

RESULTS

Overall, data of 57 patients were analyzed. Logarithmically transformed intestinal fatty acid-binding protein levels were significantly associated with cumulative fluid balance per body weight at 24 and 72 h post-intensive care unit admission both before (Pearson's r = 0.490 [95% confidence interval: 0.263-0.666]; P < 0.001 and r = 0.479 [95% confidence interval: 0.240-0.664]; P < 0.001, respectively) and after (estimate, 14.4 [95% confidence interval: 4.1-24.7]; P = 0.007 and estimate, 26.9 [95% confidence interval: 11.0-42.7]; P = 0.001, respectively) adjusting for severity score and renal function.

CONCLUSIONS

Enterocyte injury was significantly associated with cumulative fluid balance at 24 and 72 h post-intensive care unit admission. Enterocyte injury in patients with septic shock may be related to excessive fluid accumulation during the early period after intensive care unit admission.

摘要

背景

脓毒性休克患者所需的液体量不同。休克引起的肠上皮细胞损伤可能会通过触发系统性炎症反应或在存在肠缺血/坏死的情况下引起缺血再灌注损伤，从而增加液体需求。本研究旨在评估脓毒性休克患者肠上皮细胞损伤与正性液体平衡之间的关系。

方法

这是一项评估血清肠型脂肪酸结合蛋白（一种肠上皮细胞损伤的生物标志物）与脓毒性休克患者死亡率之间关系的前瞻性观察性研究的事后探索性分析。在入住重症监护病房时记录肠型脂肪酸结合蛋白水平，并从入住重症监护病房到第 7 天监测液体平衡。评估入住重症监护病房时肠型脂肪酸结合蛋白水平与入住重症监护病房后早期输注平衡之间的关系。进行了多重线性回归分析，并对严重程度评分和肾功能进行了调整。

结果

总体上，对 57 例患者的数据进行了分析。经对数转换后的肠型脂肪酸结合蛋白水平与入住重症监护病房后 24 和 72 小时内的体重累积液体平衡显著相关，这两个时间点在调整严重程度评分和肾功能之前（Pearson r 值分别为 0.490[95%置信区间：0.263-0.666]；P<0.001 和 r 值分别为 0.479[95%置信区间：0.240-0.664]；P<0.001），调整后（估计值分别为 14.4[95%置信区间：4.1-24.7]；P=0.007 和 26.9[95%置信区间：11.0-42.7]；P=0.001）。