Z Gastroenterol 2011; 49 - V132
DOI: 10.1055/s-0031-1285268

Delayed gastric emptying determines prognosis in critically ill patients with sepsis

T Liebregts 1, 2, B Adam 1, 2, C Greis 1, T Neumann 3, R Erbel 3, G Holtmann 4
  • 1Universitätsklinikum Essen, Westdeutsches Tumorzentrum, Klinik für Knochenmarktransplantation, Essen, Germany
  • 2Hanson Institute, Nerve-Gut Research Laboratory, Adelaide, Australia
  • 3Universitätsklinikum Essen, Westdeutsches Herzzentrum, Klinik für Kardiologie, Essen, Germany
  • 4Princess Alexandra Hospital, Dept. of Gastroenterology and Hepatology, Brisbane, Australia

Background: Delayed gastric emptying (GE) is a frequent finding in critically ill patients and potentially associated with increased rates of morbidity and mortality. While animal models suggest that bacterial endotoxin- induced cytokine release is associated with gastrointestinal motility dysfunction in sepsis, clinical data is lacking.

We hypothesized that delayed GE is associated with length of stay, overall survival and linked to immune activation as reflected by cytokine release.

Methods: Twenty mechanically ventilated patients with sepsis were recruited within 48h of admission to ICU at a tertiary care hospital. Patients were sedated with similar doses of midazolame and morphine. Severity of disease was classified by acute physiology and chronic health evaluation (APACHE II) score, sequential organ failure assessment score (SOFA) and multiple organ dysfunction score (MODS). GE was assessed by acetaminophen absorption test [Tarling et al. Intensive Care Med. 1997]. Briefly, 2g acetaminophen was administered with 20ml water via a nasogastric tube. Blood samples were drawn a t=0, 30, 60, 90 and 120min for measurement of acetaminophen levels determined by enzymatic degradation method. A gastric emptying time (GET) of >600mg/min/L was considered as delayed. Cytokine production was measured in cell culture supernatants of freshly isolated peripheral blood mononuclear cells and serum samples (TNF-α, IL-1β, IL-10) by ELISA.

Results: Out of 20 patients 12 showed delayed GE (1553.75±304.77 vs. 401.57±64.9mg/min/L). Patients who died (n=11) at ICU showed significantly slower GET on admission compared to (n=9) survivors (1366.8±337.66 vs. 639.75±162.3mg/min/L). Patients with and without delayed GE did not differ significantly for APACHE II (22.9±5.36 vs. 27.5±4.99) SOFA (12.6±2.27 vs. 13.25±4.83) and MODS (9±1.63 vs. 12.5±1.67) but had a significantly extended length of stay (48.20±10.88 vs. 11.86±14.87 days). Patients with delayed GE demonstrated significantly higher PBMC- induced (221.9±48.9 vs.155.9±18pg/ml) and serum IL-1β (242.4±58.1 vs. 114.8±23.2) levels compared to patients with normal GET.

Conclusion: GET on admission is a strong prognostic marker in critically ill with sepsis. Delayed gastric emptying is potentially linked to IL-1β secretion.