Study Finds What’s Causing Digestive Dysfunctions in Critically Ill Patients

A Chinese study has found that a plasma protein called heparin-binding protein (HBP) is causing acute gastrointestinal injury (AGI) abnormalities in critically ill patients. The first-ever observational study on a common condition known as digestive or gastrointestinal injury (GI) was conducted by Chinese researchers and published in the British Medical Journal (BMJ).

The researchers did a clinical observational study in which they analyzed those adult patients who were suffering from AGI which can be defined as malfunctioning of the GI tract in critically ill patients due to their acute illness. According to a meta-analysis published in The National Center for Biotechnology Information (NCBI), the prevalence of AGI in critically ill patients was 40% whereas the mortality rate was 33%.

The current analysis has been done for consecutive five days in the intensive care unit (ICU) because 62% of the patients showed symptoms of GI in ICU, according to a previous report by NCBI. The functions of GI tracts are to ingest, digest, and absorb nutrients from food and water. So, when AGI occurs, it results in feeding intolerance (FI) or intolerance to enteral nutrition (EN) in which the body could not get a proper amount of kilocalorie (kcal).

The team observed a total data consisted on 3582 patients admitted into ICU from which 3361 patients were dismissed because of some underlying conditions including so many patients stayed in ICU for less than five days, HBP tested only once, chronic organ dysfunction (hepatic or renal dysfunction), terminal cancer, coagulation dysfunction, and malnutritions. So, there were only 221 patients left that lied understudy criteria. The team divided them into four groups according to HBP levels including HBP ≤10 ng/ mL, HBP >10 ≤20 ng/mL, HBP >20 ≤40 ng/mL, and HBP >40 ng/mL.

Source: BMJ

In this analysis, the investigators measured of clinical severity and resulting variables along with five main things including measurements of a total number of patients that received EN and those patients who experienced FI, and a condition known as sepsis which is a life-threatening condition caused by the body’s defense system when the immune system works overtime to fight infection.

Source: bioMérieux Connection

They also measured primary and secondary AGI. The primary AGI included abdominal trauma, the neutrophils (a type of white blood cells) of damaged intestinal barrier release HBP which result into increase in blood HBP which further can cause vascular leakage and tissue edema and then result in entro-genus infection and other organ injuries even Multiple Organ Dysfunction Syndrome (MODS). On another hand, the secondary AGI, things that can be a way that stimulates neutrophils in the blood that can be a way in releasing HBP are sepsis, bacteria, or lipopolysaccharide (LPS). So, the high amount of HBP can result in impairment in endothelial cell barriers of intestinal vessels which further cause GI injury.

The Measurements of Data: The primary data including demographics that involved age, gender, and cause of admission in the ICU were extracted from the hospital’s archival record. The team did HBP measurements twice or more for consecutive five days which included those patients with underlying conditions such as inflammation, infection, sepsis, trauma, burn, hypotension, shock, and organ dysfunction.

After the statistical analysis, the team found out that 57 patients had no such condition as AGI at the admission time in ICU. A total of 68 and 96 patients had experienced primary AGI and secondary AGI, respectively, during ICU stay.

Surgery Before ICU Admission: A total of 177 patients had gone through surgery of which 55 patients were those who experienced abdominal surgery. There were 71% of the patients who received EN of which 38.5% of the patients had experienced the symptom of FI during EN. The condition, sepsis, was experienced by 58 patients whereas 12.2% of the patients died due to MODS and other infectious complications during the hospital stay.

There is still a need for more research on the correlation between HBP and GI dysfunctions because of the study in its initial stages. So, more work will give a clearance of current results.

This study was reviewed and approved by the institutional review board of Nanjing First Hospital and supported by the National Natural Science Foundation of China and the Nanjing Medical Science and Technology Development Foundation.

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