Volume 12 Supplement 5

Sepsis 2008

Open Access

Microcirculation changes following acute and chronic portal hypertension and their response towards bacterial translocation challenge

  • Ricardo Toma1,
  • Ana Liberatore1,
  • Jose Menchaca-Diaz1 and
  • Ivan Koh1
Critical Care200812(Suppl 5):P18

https://doi.org/10.1186/cc7051

Published: 18 November 2008

Background

Patients with cirrhosis have higher risk of infection and multiorgan dysfunction syndrome. Increasing evidence relates them to the higher susceptibility to bacterial translocation (BT) by liver dysfunction and hemodynamic changes. Herein, we evaluated the role of BT in acute and chronic portal hypertension (a-PH and c-PH) states without cirrhoses.

Methods

Forty-eight Wistar rats were distributed in BT, a-PH, c-PH with/without BT and control groups. a-PH (minimal shunting) and c-PH (extensive shunting) were induced by calibrated portal vein stenosis and were submitted to BT on days 2 and 14, respectively, by oroduodenal inoculation (10 ml Escherichia coli R-6, 107 or 1010 colony-forming units (CFU)/ml) and confinement into the small bowel for 2 hours. BT-sham (saline), PH-sham (without portal stenosis), and PH groups were monitored for splachnic (liver, spleen, ileum) and kidney perfusion by laser Doppler, and mesenteric lymph node (MLN), liver, spleen, lung, blood and peritoneal fluid (PF) samples were cultured.

Results

In the BT 1010 group, the culture was 100% positive at the MLN, liver and spleen (5.3 and 3 log10 CFU/g, respectively), while the blood, PF and lung were negative. In a-PH animals, the BT 1010 pattern was 100% to the MLN, liver and spleen (5.4 and 4 log10 CFU/g, respectively), lung (100%, 3 log10, P < 0.05) and PF (10%, 0.6 log10). In turn, c-PH-BT1010 findings were similar to BT1010 alone but there was an increased translocation to PF (40%, 1 log10, P < 0.05). On the other hand, for BT 107 all cultures were negative, but in PH-BT107 translocation occurred to the MLN (a-PH 50%, 1 log10 CFU/g; c-PH 25%, 0.7 log10 CFU/g) plus to the PF (a-PH 12.5%, 0.08 log10 CFU/g; c-PH 25%, 0.16 log10 CFU/g), evidencing a change in the gut threshold for BT in the PH state. Bacterial challenge in the a-PH state showed that the liver, spleen and kidney go into a hypoperfusion state (-38, -45.2 and -36 Δ%, respectively), in contrast to the ileum hyperperfusion response (+75 Δ%). Similarly, at c-PH the liver and kidney maintained a hypoperfusion state (-17%, -33% Δ%). Based on both saline-PH groups' data, however, the ileum and liver microcirculation functional adaptation was mostly compromised only at the chronic phase.

Conclusion

Portal hypertension factor without cirrhosis increases and changes the pattern of BT, especially to the lung at a-PH and to the PF at c-PH states, under small bowel Gram-negative bacterial overgrowth conditions. These findings, in addition to the tissue perfusion impairment, might explain the higher susceptibility to infection in portal hypertension diseases.

Authors’ Affiliations

(1)
Departments of Surgery and Pediatrics, Federal University of Sao Paulo (UNIFESP)

Copyright

© Toma et al; licensee BioMed Central Ltd. 2008

This article is published under license to BioMed Central Ltd.

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