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

• Published in: BMC anesthesiology Vol. 21; no. 1; p. 293
• Main Authors: Yokoyama, Haruka, Sekino, Motohiro, Funaoka, Hiroyuki, Sato, Shuntaro, Araki, Hiroshi, Egashira, Takashi, Yano, Rintaro, Matsumoto, Sojiro, Ichinomiya, Taiga, Higashijima, Ushio, Hara, Tetsuya
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 23.11.2021; BioMed Central; BMC
• Subjects: Aged; Analysis; Blood products; Body weight; Care and treatment; Clinical outcomes; Enterocyte damage; Enterocytes - pathology; Fatty acid-binding protein; Fatty Acid-Binding Proteins - blood; Fatty acids; Female; Fluid administration; Fluid volume; Health aspects; Hospitals; Humans; Infections; Inflammation; Intensive care unit; Intensive Care Units; Intestinal fatty acid-binding protein; Intestinal mucosal cell; Intestine; Ischemia; Japan; Male; Medical research; Medicine, Experimental; Middle Aged; Mortality; Observational studies; Patients; Physicians; Prospective Studies; Protein binding; Renal function; Reperfusion; Sepsis; Septic shock; Severity of Illness Index; Shock, Septic - mortality; Shock, Septic - physiopathology; Time Factors; Ventilators; Water-Electrolyte Balance - physiology; Japan; Intestinal mucosal cell; Intestinal fatty acid-binding protein; Enterocyte damage; Fluid volume; Sepsis; Septic shock; Fluid administration; Intensive care unit
• ISSN: 1471-2253; 1471-2253
• DOI: 10.1186/s12871-021-01515-2

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. 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. 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. 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.