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Intestinal corticotropin-releasing factor is decreased in shocked trauma patients and may affect gut function
Critical Care volume 11, Article number: P150 (2007)
The reasons for the typical bowel dysfunction following traumatic injury are unclear. Corticotropin-releasing factor (CRF) in peripheral blood/tissue may induce intestinal barrier dysfunction via receptor-mediated mechanisms independently of the hypothalamic–pituitary–adrenal axis. This mechanism seems to involve interactions of CRF with enteric nerves and mast cells, which results in increased gut intercellular tight junction permeability to macromolecules, as well as increased epithelial cell apoptosis leading to loss of mucosal integrity. We investigated whether blood and intestinal tissue CRF is associated with postoperative gut dysfunction in shock.
CRF analysis was performed on full-thickness bowel specimens obtained from shocked trauma patients requiring emergency abdominal surgery for penetrating injury, and from patients undergoing small bowel resection during elective bowel surgery. Venous blood was taken before anaesthesia, intra-operatively and on postoperative day 1. CRF extracted from tissue and blood was quantified using radioimmunoassay. On day 1 postoperatively, intestinal permeability was tested by urinary lactulose:mannitol (L:M) measurement. Institutional ethical approval was granted and patients gave written informed consent.
Trauma patients (n = 6, male/female = 6/0, age 27 ± 10.2 years, ISS 23 ± 6.8) were younger than elective patients (n = 6, male/female = 4/2, age 52.8 ± 7.7 years, P < 0.0006), and had significantly lower mean tissue [CRF] (0.034 ± 0.015 × 10-3% total protein (TP)) than elective patients (0.117 ± 0.075 × 10-3%TP, P = 0.023). The median (IQR) intraoperative blood CRF level was higher in trauma patients (86.7 (5.5) pg/ml vs 59.8 (9.6) pg/ml, P = 0.03) than elective patients. In trauma patients this correlated negatively with postoperative L:M (r = -0.9, P = 0.037), although intestinal permeability was greatly and equally increased in both groups (combined mean ± SD L:M, 0.58 ± 0.55).
CRF is detectable in bowel tissue following trauma and is significantly lower in trauma vs elective surgery patients, while CRF in blood may be a factor associated with gut barrier changes following shock and emergency laparotomy.
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Michell, W., Hill, L., Hendricks, S. et al. Intestinal corticotropin-releasing factor is decreased in shocked trauma patients and may affect gut function. Crit Care 11, P150 (2007). https://doi.org/10.1186/cc5310
- Trauma Patient
- Intestinal Permeability
- Bowel Dysfunction
- Elective Patient