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New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery.

Derikx JP, van Waardenburg DA, Thuijls G, Willigers HM, Koenraads M, van Bijnen AA, Heineman E, Poeze M, Ambergen T, van Ooij A, van Rhijn LW, Buurman WA - PLoS ONE (2008)

Bottom Line: Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP.Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively).These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Hospital Maastricht & Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, the Netherlands.

ABSTRACT

Background: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery.

Methodology/principal findings: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively).

Conclusions/significance: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

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Related in: MedlinePlus

Translated values of plasma levels of circulating I-FABP and translated values of preceding systemic hypotension (MAP t-½hr) in children undergoing spinal fusion surgery were plotted.Circulating I-FABP correlated significantly negatively with MAP at ½ hour before blood sampling (n = 89, correlation: −0.726 (p<0.001). Translations of both variables are specific for an individual in such a way that all within-person means correspond to the zeros in the plot. In this way the variation of individual levels are cancelled and the pure association of both variables remains.
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pone-0003954-g003: Translated values of plasma levels of circulating I-FABP and translated values of preceding systemic hypotension (MAP t-½hr) in children undergoing spinal fusion surgery were plotted.Circulating I-FABP correlated significantly negatively with MAP at ½ hour before blood sampling (n = 89, correlation: −0.726 (p<0.001). Translations of both variables are specific for an individual in such a way that all within-person means correspond to the zeros in the plot. In this way the variation of individual levels are cancelled and the pure association of both variables remains.

Mentions: The very short circulating half-life of FABP (approximately 11 minutes) [27] allows to relate the presence of enterocyte cell damage with preceding systemic hypotension and gastric mucosal hypoperfusion. To this end within-person correlations were studied between circulating levels of I-FABP, I-BABP and intraoperative MAP at ½ hour before the blood sample was collected in which FABP concentration was measured, and PrCO2, Pr-aCO2-gap at the same moment of blood sampling. Interestingly, plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at ½ hour before blood sampling (correlation: −0.726 (p<0.001); −0.483 (P<0.001), respectively), indicating a relationship between enterocyte cell damage and preceding systemic hypotension (Figure 3, Table 2). Furthermore, circulating values of I-FABP correlated with gastric mucosal PrCO2 and Pr-aCO2-gap measured at the same time points (correlation: 0.553 (p = 0.040) and 0.585 (p = 0.028), respectively), whereas no correlation was observed between plasma levels of I-BABP and PrCO2 or Pr-aCO2-gap. These data show a clear association between the most prominent plasma marker for enterocyte cell death (I-FABP), hypotension and splanchnic hypoperfusion, assessed by gastric mucosal PrCO2 and Pr-aCO2-gap.


New Insight in Loss of Gut Barrier during Major Non-Abdominal Surgery.

Derikx JP, van Waardenburg DA, Thuijls G, Willigers HM, Koenraads M, van Bijnen AA, Heineman E, Poeze M, Ambergen T, van Ooij A, van Rhijn LW, Buurman WA - PLoS ONE (2008)

Translated values of plasma levels of circulating I-FABP and translated values of preceding systemic hypotension (MAP t-½hr) in children undergoing spinal fusion surgery were plotted.Circulating I-FABP correlated significantly negatively with MAP at ½ hour before blood sampling (n = 89, correlation: −0.726 (p<0.001). Translations of both variables are specific for an individual in such a way that all within-person means correspond to the zeros in the plot. In this way the variation of individual levels are cancelled and the pure association of both variables remains.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2599890&req=5

pone-0003954-g003: Translated values of plasma levels of circulating I-FABP and translated values of preceding systemic hypotension (MAP t-½hr) in children undergoing spinal fusion surgery were plotted.Circulating I-FABP correlated significantly negatively with MAP at ½ hour before blood sampling (n = 89, correlation: −0.726 (p<0.001). Translations of both variables are specific for an individual in such a way that all within-person means correspond to the zeros in the plot. In this way the variation of individual levels are cancelled and the pure association of both variables remains.
Mentions: The very short circulating half-life of FABP (approximately 11 minutes) [27] allows to relate the presence of enterocyte cell damage with preceding systemic hypotension and gastric mucosal hypoperfusion. To this end within-person correlations were studied between circulating levels of I-FABP, I-BABP and intraoperative MAP at ½ hour before the blood sample was collected in which FABP concentration was measured, and PrCO2, Pr-aCO2-gap at the same moment of blood sampling. Interestingly, plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at ½ hour before blood sampling (correlation: −0.726 (p<0.001); −0.483 (P<0.001), respectively), indicating a relationship between enterocyte cell damage and preceding systemic hypotension (Figure 3, Table 2). Furthermore, circulating values of I-FABP correlated with gastric mucosal PrCO2 and Pr-aCO2-gap measured at the same time points (correlation: 0.553 (p = 0.040) and 0.585 (p = 0.028), respectively), whereas no correlation was observed between plasma levels of I-BABP and PrCO2 or Pr-aCO2-gap. These data show a clear association between the most prominent plasma marker for enterocyte cell death (I-FABP), hypotension and splanchnic hypoperfusion, assessed by gastric mucosal PrCO2 and Pr-aCO2-gap.

Bottom Line: Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP.Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively).These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, University Hospital Maastricht & Nutrition and Toxicology Research Institute (NUTRIM), Maastricht University, Maastricht, the Netherlands.

ABSTRACT

Background: Gut barrier loss has been implicated as a critical event in the occurrence of postoperative complications. We aimed to study the development of gut barrier loss in patients undergoing major non-abdominal surgery.

Methodology/principal findings: Twenty consecutive children undergoing spinal fusion surgery were included. This kind of surgery is characterized by long operation time, significant blood loss, prolonged systemic hypotension, without directly leading to compromise of the intestines by intestinal manipulation or use of extracorporeal circulation. Blood was collected preoperatively, every two hours during surgery and 2, 4, 15 and 24 hours postoperatively. Gut mucosal barrier was assessed by plasma markers for enterocyte damage (I-FABP, I-BABP) and urinary presence of tight junction protein claudin-3. Intestinal mucosal perfusion was measured by gastric tonometry (P(r)CO2, P(r-a)CO2-gap). Plasma concentration of I-FABP, I-BABP and urinary expression of claudin-3 increased rapidly and significantly after the onset of surgery in most children. Postoperatively, all markers decreased promptly towards baseline values together with normalisation of MAP. Plasma levels of I-FABP, I-BABP were significantly negatively correlated with MAP at (1/2) hour before blood sampling (-0.726 (p<0.001), -0.483 (P<0.001), respectively). Furthermore, circulating I-FABP correlated with gastric mucosal P(r)CO2, P(r-a)CO2-gap measured at the same time points (0.553 (p = 0.040), 0.585 (p = 0.028), respectively).

Conclusions/significance: This study shows the development of gut barrier loss in children undergoing major non-abdominal surgery, which is related to preceding hypotension and mesenterial hypoperfusion. These data shed new light on the potential role of peroperative circulatory perturbation and intestinal barrier loss.

Show MeSH
Related in: MedlinePlus