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Gut mucosal cell damage in meningococcal sepsis in children: relation with clinical outcome

Joep P M Derikx1, Else M Bijker, Gijs D Vos

  • 1Department of Surgery, Maastricht University Medical Centre & Nutrition and Toxicology Research Institute, Maastricht, The Netherlands.

Critical Care Medicine
|September 5, 2009
PubMed

Insights

Meningococcal sepsis in children can cause enterocyte damage, indicated by elevated intestinal fatty acid binding protein (IFABP) levels. Non-survivors showed prolonged IFABP elevation, suggesting its role in disease severity and outcome.

Area of Science:

  • Pediatric critical care medicine
  • Gastroenterology
  • Infectious diseases

Background:

  • Meningococcal sepsis pathophysiology involves microvascular dysfunction and impaired tissue perfusion.
  • Mature enterocytes are vulnerable to compromised blood flow, potentially leading to damage.
  • Understanding enterocyte injury in pediatric sepsis is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the development of enterocyte damage in children with meningococcal sepsis.
  • To determine the relationship between enterocyte damage and disease severity.
  • To explore the association between enterocyte damage and clinical outcomes in pediatric meningococcal sepsis.

Main Methods:

  • Retrospective study of 19 children admitted to a pediatric intensive care unit with meningococcal sepsis.
  • Measurement of circulating intestinal fatty acid binding protein (IFABP) levels upon admission.
  • Assessment of disease severity using the Rotterdam Score, Pediatric Risk of Mortality II, and interleukin-6 levels.
  • Correlation analysis between IFABP levels and clinical outcomes, including length of ICU stay and ventilator days.

Main Results:

  • Eight of 19 patients presented with elevated plasma IFABP levels at admission, indicating enterocyte damage.
  • IFABP levels correlated significantly with disease severity scores (Rotterdam Score, PRISM II) and interleukin-6.
  • Survivors showed declining IFABP levels within 12 hours of treatment, while non-survivors maintained elevated levels.
  • A significant correlation was observed between IFABP levels and clinical outcomes.

Conclusions:

  • Elevated plasma IFABP suggests enterocyte damage in children with severe meningococcal sepsis at presentation.
  • Persistent enterocyte damage, indicated by prolonged IFABP elevation, is associated with non-survival.
  • Plasma IFABP may serve as a potential biomarker for monitoring treatment efficacy in pediatric sepsis.
Abstract

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