Tomoki Yamada1, Kentaro Shimizu2, Hiroshi Ogura2, Takashi Asahara3, Koji Nomoto3, Kazuma Yamakawa2, Toshimitsu Hamasaki4, Yasutaka Nakahori5, Mitsuo Ohnishi2, Yasuyuki Kuwagata6, Takeshi Shimazu2. 1. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan tomoki27@hp-emerg.med.osaka-u.ac.jp. 2. Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School, Osaka, Japan. 3. Yakult Central Institute for Microbiological Research, Tokyo, Japan. 4. Department of Biomedical Statistics, Osaka University Graduate School of Medicine, Osaka, Japan. 5. Department of Emergency and Critical Care, Osaka General Medical Center, Osaka, Japan. 6. Department of Emergency and Critical Care Medicine, Kansai Medical University, Hirakata-City, Osaka, Japan.
Abstract
BACKGROUND: The gut is an important target organ for injury after severe insult. Short-chain fatty acids (SCFAs) are end-products of fermentation of dietary fibers by anaerobic microbiota. They are related to intestinal energy, motility, and transport and to protective effects against infection and inflammation. However, there are few clinical data on SCFAs in critically ill patients. We evaluated serial change in fecal SCFAs in patients with severe systemic inflammatory response syndrome (SIRS). PATIENTS AND METHODS: This study included 140 intensive care unit (ICU) patients who fulfilled the criteria of SIRS and had a serum C-reactive protein level of >10 mg/dL. A fecal sample was used for quantitative measurement of fecal SCFA (butyrate, propionate, and acetate) concentrations by high-performance liquid chromatography. Fecal SCFAs were evaluated weekly for 6 weeks after admission. Data obtained from patients were compared with corresponding data from healthy volunteers. RESULTS: SIRS resulted from infection in 78 patients, trauma in 30, burns in 12, and other causes in 20. Fecal concentrations of butyrate, propionate, and acetate in these patients decreased significantly compared with those in healthy volunteers and remained low throughout the 6 weeks of the patients' ICU stay. Fecal concentrations of SCFAs in the patients with gastrointestinal complications, including enteritis and dysmotility, were lower than those in the patients without gastrointestinal complications. CONCLUSIONS: Concentrations of fecal SCFAs in patients with severe SIRS were significantly lower than those in healthy volunteers over a 6-week period. Maintenance of SCFAs may have therapeutic potential to prevent gastrointestinal complications in critically ill patients.
BACKGROUND: The gut is an important target organ for injury after severe insult. Short-chain fatty acids (SCFAs) are end-products of fermentation of dietary fibers by anaerobic microbiota. They are related to intestinal energy, motility, and transport and to protective effects against infection and inflammation. However, there are few clinical data on SCFAs in critically illpatients. We evaluated serial change in fecal SCFAs in patients with severe systemic inflammatory response syndrome (SIRS). PATIENTS AND METHODS: This study included 140 intensive care unit (ICU) patients who fulfilled the criteria of SIRS and had a serum C-reactive protein level of >10 mg/dL. A fecal sample was used for quantitative measurement of fecal SCFA (butyrate, propionate, and acetate) concentrations by high-performance liquid chromatography. Fecal SCFAs were evaluated weekly for 6 weeks after admission. Data obtained from patients were compared with corresponding data from healthy volunteers. RESULTS: SIRS resulted from infection in 78 patients, trauma in 30, burns in 12, and other causes in 20. Fecal concentrations of butyrate, propionate, and acetate in these patients decreased significantly compared with those in healthy volunteers and remained low throughout the 6 weeks of the patients' ICU stay. Fecal concentrations of SCFAs in the patients with gastrointestinal complications, including enteritis and dysmotility, were lower than those in the patients without gastrointestinal complications. CONCLUSIONS: Concentrations of fecal SCFAs in patients with severe SIRS were significantly lower than those in healthy volunteers over a 6-week period. Maintenance of SCFAs may have therapeutic potential to prevent gastrointestinal complications in critically illpatients.
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