Gut Alterations in Septic Patients: A Biochemical Literature Review

Area of Science:

• Gastroenterology
• Critical Care Medicine
• Microbiology

Background:

• Sepsis is a life-threatening condition causing organ dysfunction and high mortality.
• Gastrointestinal tract damage, including increased permeability and bacterial translocation, is common in sepsis.
• Intestinal alterations can be both a cause and consequence of sepsis progression.

Purpose of the Study:

• To review pathways leading to intestinal alterations in sepsis.
• To explore methods for measuring intestinal permeability.
• To evaluate if these measurements can identify high-risk sepsis patients and predict prognosis.

Main Methods:

• Systematic review of PubMed articles using keywords: sepsis, gut alteration, bowel permeability, bacterial translocation, gut permeability tests, gut inflammation.
• Selection of 105 relevant articles after initial screening of 321 papers.
• Exclusion of duplicate studies and research on pediatric populations.

Main Results:

• Intestinal barrier integrity is crucial for preventing bacterial translocation in sepsis.
• Early identification of patients with intestinal dysfunction, malabsorption, or malnutrition is vital for survival.
• Citrulline dosage is a practical and accurate clinical test for assessing enterocyte function in critically ill patients.

Conclusions:

• Sepsis severely affects gastrointestinal function and intestinal permeability, potentially leading to systemic infection.
• While current biological markers lack specificity, emerging markers like LPS, citrulline, lactulose/mannitol test, FABP, and fecal calprotectin show high sensitivity and specificity.
• Assessing gut permeability is crucial for managing sepsis patients.