Acute and Critical Care

Original Articles

Nutrition
Associations between systemic inflammation and intestinal permeability with Onodera's prognostic nutritional index in critically ill patients: Seyed Hossein Ardehali, Ghazaleh Eslamian, Shirin Malek; Acute Crit Care. 2021;36(4):361-368. Published online November 26, 2021; DOI: https://doi.org/10.4266/acc.2021.00178

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Background
Malnutrition is a potentially costly problem in critically ill patients admitted to the intensive care unit (ICU). The aim of this study is to evaluate the relationships between the Onodera’s prognostic nutritional index (OPNI) and intestinal permeability and between OPNI and systemic inflammation in critically ill patients.
Methods
This was a cross-sectional study conducted in the general ICU of a university-affiliated hospital. A total of 162 ICU-hospitalized adult patients admitted between May 2018 and December 2019, was included in the study sample. The OPNI was calculated at admission and categorized as ≤40 or >40. We assessed plasma endotoxin and zonulin concentrations as markers of intestinal permeability as well as serum interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) as markers of systemic inflammation upon admission under stringent conditions. The relationships between these markers and OPNI were assessed after adjusting for potential confounders through estimation of a binary logistic regression model.
Results
Median (interquartile range) hs-CRP, IL-6 zonulin, and endotoxin were significantly greater in the low OPNI subgroup than in the high OPNI subgroup (all P<0.05). Multivariate analyses showed significant association between serum IL-6 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.64–0.96), serum hs-CRP (OR, 0.77; 95% CI, 0.53–0.92), plasma endotoxin (OR, 0.81; 95% CI, 0.72–0.93), and plasma zonulin (OR, 0.83; 95% CI, 0.75–0.98) levels with OPNI in the overall population.
Conclusions
Our results provide evidence that higher plasma endotoxin, zonulin, IL-6, and hs-CRP levels are associated with progressively lower OPNI in mixed ICU populations, particularly in surgical ICU patients.

Citations

Citations to this article as recorded by

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study
Moon Seong Baek, Young Suk Kwon, Sang Soo Kang, Daechul Shim, Youngsang Yoon, Jong Ho Kim
Acute and Critical Care.2024; 39(1): 127. CrossRef
Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease
Ramazan Baldemir, Mustafa Özgür Cirik
Medicine.2022; 101(24): e29433. CrossRef
Nutritional Status, Body Composition, and Inflammation Profile in Older Patients with Advanced Chronic Kidney Disease Stage 4–5: A Case-Control Study
Mar Ruperto, Guillermina Barril
Nutrients.2022; 14(17): 3650. CrossRef

Association of Hyperlactatemia and IL-6 Hypercytokinemia after Cardiopulmonary Bypass: A Preliminary Report: Sang Hoon Yoon, Seung Zhoo Yoon, Hye Won Shin, Sung Uk Choi, Choon Hak Lim; Korean J Crit Care Med. 2011;26(1):18-23.; DOI: https://doi.org/10.4266/kjccm.2011.26.1.18

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Abstract PDF: BACKGROUND
In cardiac surgery with cardiopulmonary bypass (CPB), hyperlactatemia (HL) is common and is associated with postoperative morbidity and mortality. At present, the cause of HL during CPB is proposed to be tissue hypoxia. Tissue perfusion and oxygen delivery can be impaired to varying degrees during CPB. Although surgery involving CPB apparatus is associated with increased pro-inflammatory mediators, such as TNF-alpha and IL-6, tissue hypoxia that occurs during CPB may be an additionally potent stimulus to inflammation. We hypothesized that hypoxic patients during CPB that experience elevated serum lactate levels, may be related to higher serum cytokine level after CPB than normoxic patients during CPB with normal serum lactate levels.
METHODS
Levels of TNF-alpha and IL-6 were measured by ELISA in a) Time 1; before initiation of CPB, b) Time 2; 30 min after aortic de-clamping, c) Time 3; 24 hrs after aortic de-clamping. Levels of lactate was measured at a) Time A; before initiation of CPB, b) Time B; 30 min after aortic de-clamping. Postoperative ICU stay, intubation time and oxygen index were evaluated as postoperative morbidity scale.
RESULTS
There were no statistical differences between HL (n = 43, lactate > or =3 mMol/L at time B) and normal lactate group (NL) (n = 63, lactate <3 mMol/L at time B) in demographic data, preoperative left ventricular ejection fraction, CPB time, and aortic cross-clamp time. Level of IL-6 in HL at time 3 was higher than that of NL. The ICU stay and intubation time were longer in HL. The oxygen index on 1st postoperative day was lower in HL.
CONCLUSIONS
Our results suggest that hyperlactatemia after weaning from CPB may be related to IL-6 hypercytokinemia, and therefore related to postoperative morbidity.

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