Increased intestinal permeability accompanies the development of sepsis in ICU patients

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Introduction

The concept of bacterial/toxin translocation from the gut as the source of sepsis is well recognized. Continuous monitoring of gut permeability in correlation with clinical signs of sepsis is poorly documented. We measured daily intestinal permeability of patients admitted to the ICU and correlated it with signs of sepsis.

Methods

Design: prospective, observational study. Population: twelve consecutive patients admitted to the ICU with an expected admission of three days or more. Three patients were septic on admission and nine were not. Six out of the nonseptic group developed signs of sepsis during their ICU stay. Permeability measurement: each of the 12 patients received 5 g of Mannitol and 10 g of Lactulose daily (from ICU admission up to seven days), through their NG tube. Urine was collected every 24 h, and an aliquot of 40 ml was kept at -20°C for subsequent high pressure liquid chromatography, to measure the secretion of Mannitol and Lactulose. The ratio of Lactulose/Mannitol (L/M) was calculated. Signs of sepsis (according to Bone's criteria: Ann Int Med, 1991) were recorded daily.

Results

A total of nine septic patients showed a significant increase of L/M compared to nine non-septic patients (21.2 ± 0.3 vs 4.3 ± 0.4, P<0.05). The six patients who developed sepsis during their ICU stay showed a significant rise of L/M while becoming septic (28.7 ± 0.2 during sepsis, vs 4.8 ± 0.3 when not septic, P<0.05).

Conclusions

Increased intestinal permeability is associated with clinical signs of sepsis, thus substantiating the role of gut permeability as a major defect in the evolvement of sepsis and its sequelae.