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Associations between systemic inflammation and intestinal permeability with Onodera's prognostic nutritional index in critically ill patients

Ghazaleh Eslamian|Seyed Hossein Ardehali|Shirin Malek
대한중환자의학회 (The Korean Society Of Critical Care Medicine)|2021.11|Acute and Critical Care|제36권 제4호|pp. 361-368|DOI 10.4266/acc.2021.00178

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키워드

C-reactive proteinintensive care unitinterleukin-6endotoxinzonulinOnodera

초록

Background: Malnutrition is a serious condition in critically ill patients. 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 intensive care unit (ICU) of a university-affiliated hospital. A total of 162 patients admitted between May 2018 and December 2019, was included in the study. 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 hsCRP levels are associated with progressively lower OPNI in mixed ICU populations, particularly in surgical ICU patients.

Abstract

Background: Malnutrition is a serious condition in critically ill patients. 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 intensive care unit (ICU) of a university-affiliated hospital. A total of 162 patients admitted between May 2018 and December 2019, was included in the study. 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 hsCRP levels are associated with progressively lower OPNI in mixed ICU populations, particularly in surgical ICU patients.

참고문헌 (36)

  1. Osooli F, "Identifying critically ill patients at risk of malnutrition and underfeeding : a prospective study at an academic hospital", Adv Pharm Bull, 9, pp.314~320 (2019)
  2. McWhirter JP, "Incidence and recognition of malnutrition in hospital", BMJ, 308, pp.945~948 (1994)
  3. Kubrak C, "Malnutrition in acute care patients : a narrative review", Int J Nurs Stud, 44, pp.1036~1054 (2007)
  4. Verity S, "Nutrition and its importance to intensive care patients", Intensive Crit Care Nurs, 12, pp.71~78 (1996)
  5. Sertaridou E, "Gut failure in critical care : old school versus new school", Ann Gastroenterol, 28, pp.309~322 (2015)
  6. Hoffer LJ, "Nutrition in critical illness : a current conundrum", F1000Res, 5, pp.2531~ (2016)
  7. Preiser JC, "Metabolic response to the stress of critical illness", Br J Anaesth, 113, pp.945~954 (2014)
  8. MacFie J, "Gut origin of sepsis: a prospective study investigating associations between bacterial translocation, gastric microflora, and septic morbidity", Gut, 45, pp.223~228 (1999)
  9. Prins A, "Nutritional assessment of the critically ill patient", South Afr J Clin Nutr, 23, pp.11~18 (2010)
  10. Manzanares W, "Restoring the microbiome in critically ill patients: are probiotics our true friends when we are seriously ill?", JPEN J Parenter Enteral Nutr, 41, pp.530~533 (2017)
  11. Onodera T, "Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients", Nihon Geka Gakkai Zasshi, 85, pp.1001~1005 (1984)
  12. Jian-Hui C, "Significance of Onodera’s prognostic nutritional index in patients with colorectal cancer : a large cohort study in a single Chinese institution", Tumour Biol, 37, pp.3277~3283 (2016)
  13. Matsumoto H, "Prognosis prediction for postoperative esophageal cancer patients using Onodera’s prognostic nutritional index", Nutr Cancer, 69, pp.849~854 (2017)
  14. Broggi MS, "Onodera’s prognostic nutritional index as an independent prognostic factor in clear cell renal cell carcinoma", Urology, 96, pp.99~105 (2016)
  15. Derya Yenibertiz, "Is Onodera’s prognostic nutritional index (OPNI) a prognostic factor in small cell lung cancer (SCLC)?", The Clinical Respiratory Journal, 14(8), pp.689~694 (2020), Wiley[DOI]
  16. Chan AW, "Prognostic nutritional index(PNI)predicts tumor recurrence of very early", early stage hepatocellular carcinoma after surgical resection, 2015, pp.22, 4138~4148
  17. Hong S, "The prognostic nutritional index(PNI)predicts overall survival of small-cell lung cancer patients", Tumour Biol, 36, pp.3389~3397 (2015)
  18. Knaus WA, "APACHE II : a severity of disease classification system", Crit Care Med, 13, pp.818~829 (1985)
  19. Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
  20. "American College of Chest Physicians", Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis, 1992, pp.20, 864~874
  21. Bengmark S, "Nutrition of the critically ill &#8212 : a 21st-century perspective", Nutrients, 5, pp.162~207 (2013)
  22. Tokunaga R, "Prognostic nutritional index predicts severe complications, recurrence, and poor prognosis in patients with colorectal cancer undergoing primary tumor resection", Dis Colon Rectum, 58, pp.1048~1057 (2015)
  23. Borda F, "Relation between preoperative prognostic Onodera’s index and postsurgery complications in the R0 gastric carcinoma resection", An Sist Sanit Navar, 40, pp.67~75 (2017)
  24. 강석휘, "Onodera’s Prognostic Nutritional Index as a Risk Factor for Mortality in Peritoneal Dialysis Patients", Journal of Korean Medical Science, 27(11), pp.1354~1358 (2012), 대한의학회
  25. Sachlova M, "Prognostic value of scores based on malnutrition or systemic inflammatory response in patients with metastatic or recurrent gastric cancer", Nutr Cancer, 66, pp.1362~1370 (2014)
  26. Vermeulen KM, "Phase angle and Onodera’s prognostic nutritional index in critically ill patients", Nutr Hosp, 33, pp.1268~1275 (2016)
  27. Eslamian G, "Association of intestinal permeability with a NUTRIC score in critically ill patients", Nutrition, 63(64), pp.1~8 (2019)
  28. Chohno T, "Associations between the prognostic nutritional index and morbidity", mortality during intestinal resection in patients with ulcerative colitis, 2018, pp.42, 1949~1959
  29. Milan Manani S, "Pro-inflammatory cytokines : a possible relationship with dialytic adequacy and serum albumin in peritoneal dialysis patients", Clin Kidney J, 9, pp.153~157 (2016)
  30. Don BR, "Serum albumin : relationship to inflammation and nutrition", Semin Dial, 17, pp.432~437 (2004)
  31. Fukui H, "Increased intestinal permeability and decreased barrier function: does it really influence the risk of inflammation?", Inflamm Intest Dis, 1, pp.135~145 (2016)
  32. Haussner F, "Challenge to the intestinal mucosa during sepsis", Front Immunol, 10, pp.891~ (2019)
  33. Mukhopadhyay A, "Association of modified NUTRIC score with 28-day mortality in critically ill patients", Clin Nutr, 36, pp.1143~1148 (2017)
  34. Kondrup J, "Nutritional-risk scoring systems in the intensive care unit", Curr Opin Clin Nutr Metab Care, 17, pp.177~182 (2014)
  35. Schaible UE, "Malnutrition and infection: complex mechanisms and global impacts", PLoS Med, 4, pp.e115~ (2007)
  36. Grzegorzewska AE, "Total lymphocyte count and subpopulation lymphocyte counts in relation to dietary intake and nutritional status of peritoneal dialysis patients", Adv Perit Dial, 21, pp.35~40 (2005)

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