Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults : A pilot study

Journal article


Tatucu-Babet, Oana A., Forsyth, Adrienne, Udy, Andrew, Radcliffe, Jessica, Benheim, Devin, Calkin, Caroline, Ridley, Emma J., Gantner, Dashiell, Jois, Markandeya, Itsiopoulos, Catherine and Tierney, Audrey C.. (2022). Use of a sensitive multisugar test for measuring segmental intestinal permeability in critically ill, mechanically ventilated adults : A pilot study. Journal of Parenteral and Enteral Nutrition. 46(2), pp. 454-461. https://doi.org/10.1002/jpen.2110
AuthorsTatucu-Babet, Oana A., Forsyth, Adrienne, Udy, Andrew, Radcliffe, Jessica, Benheim, Devin, Calkin, Caroline, Ridley, Emma J., Gantner, Dashiell, Jois, Markandeya, Itsiopoulos, Catherine and Tierney, Audrey C.
Abstract

Background
Increased intestinal permeability (IP) is associated with sepsis in the intensive care unit (ICU). This study aimed to pilot a sensitive multisugar test to measure IP in the nonfasted state.

Methods
Critically ill, mechanically ventilated adults were recruited from 2 ICUs in Australia. Measurements were completed within 3 days of admission using a multisugar test measuring gastroduodenal (sucrose recovery), small-bowel (lactulose-rhamnose [L-R] and lactulose-mannitol [L-M] ratios), and whole-gut permeability (sucralose-erythritol ratio) in 24-hour urine samples. Urinary sugar concentrations were compared at baseline and after sugar ingestion, and IP sugar recoveries and ratios were explored in relation to known confounders, including renal function.

Results
Twenty-one critically ill patients (12 males; median, 57 years) participated. Group median concentrations of all sugars were higher following sugar administration; however, sucrose and mannitol increases were not statistically significant. Within individual patients, sucrose and mannitol concentrations were higher in baseline than after sugar ingestion in 9 (43%) and 4 (19%) patients, respectively. Patients with impaired (n = 9) vs normal (n = 12) renal function had a higher L-R ratio (median, 0.130 vs 0.047; P = .003), lower rhamnose recovery (median, 15% vs 24%; P = .007), and no difference in lactulose recovery.

Conclusion
Small-bowel and whole-gut permeability measurements are possible to complete in the nonfasted state, whereas gastroduodenal permeability could not be measured reliably. For small-bowel IP measurements, the L-R ratio is preferred over the L-M ratio. Alterations in renal function may reduce the reliability of the multisugar IP test, warranting further exploration.

Keywordscritical care; enteral nutrition; gastroenterology
Year2022
JournalJournal of Parenteral and Enteral Nutrition
Journal citation46 (2), pp. 454-461
PublisherJohn Wiley & Sons Ltd
ISSN0148-6071
Digital Object Identifier (DOI)https://doi.org/10.1002/jpen.2110
Scopus EID2-s2.0-85105219931
Open accessPublished as green open access
Research or scholarlyResearch
Page range454-461
Author's accepted manuscript
License
All rights reserved
File Access Level
Open
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online30 Apr 2021
Publication process dates
Accepted21 Mar 2021
Deposited14 Jun 2022
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