Abstract
BackgroundThe required fluid volume differs among patients with septic shock. Enterocyte injury caused by shock may increase the need for fluid by triggering a systematic inflammatory response or an ischemia-reperfusion injury in the presence of intestinal ischemia/necrosis. This study aimed to evaluate the association between enterocyte injury and positive fluid balance in patients with septic shock.MethodsThis study was a post hoc exploratory analysis of a prospective observational study that assessed the association between serum intestinal fatty acid-binding protein, a biomarker of enterocyte injury, and mortality in patients with septic shock. Intestinal fatty acid-binding protein levels were recorded on intensive care unit admission, and fluid balance was monitored from intensive care unit admission to Day 7. The association between intestinal fatty acid-binding protein levels at admission and the infusion balance during the early period after intensive care unit admission was evaluated. Multiple linear regression analysis, with adjustments for severity score and renal function, was performed.ResultsOverall, data of 57 patients were analyzed. Logarithmically transformed intestinal fatty acid-binding protein levels were significantly associated with cumulative fluid balance per body weight at 24 and 72 h post-intensive care unit admission both before (Pearson’s r = 0.490 [95% confidence interval: 0.263–0.666]; P < 0.001 and r = 0.479 [95% confidence interval: 0.240–0.664]; P < 0.001, respectively) and after (estimate, 14.4 [95% confidence interval: 4.1–24.7]; P = 0.007 and estimate, 26.9 [95% confidence interval: 11.0–42.7]; P = 0.001, respectively) adjusting for severity score and renal function.ConclusionsEnterocyte injury was significantly associated with cumulative fluid balance at 24 and 72 h post-intensive care unit admission. Enterocyte injury in patients with septic shock may be related to excessive fluid accumulation during the early period after intensive care unit admission.
Highlights
The required fluid volume differs among patients with septic shock
We investigated the relationship between enterocyte injury in patients with septic shock and fluid balance during the early period after intensive care unit (ICU) admission
In a recent study, which reported an association between the volume of fluid infused during the first 24 h after ICU admission and prognosis, a large range of fluid volumes were administered during the first 24 h after ICU admission; these volumes ranged from 2000 mL (10th percentile) to 9288 mL (90th percentile) among patients with septic shock who required mechanical ventilation [8]
Summary
The required fluid volume differs among patients with septic shock. Enterocyte injury caused by shock may increase the need for fluid by triggering a systematic inflammatory response or an ischemia-reperfusion injury in the presence of intestinal ischemia/necrosis. This study aimed to evaluate the association between enterocyte injury and positive fluid balance in patients with septic shock. Several studies have demonstrated an association between positive fluid balance and poor outcomes in patients with septic shock [4,5,6,7]. Infusion of excess fluid that deviates from the appropriate preload should be avoided, and fluid restriction must be applied to improve the prognosis. Other factors such as enterocyte injury may promote a positive fluid balance due to increased fluid requirements and may be associated with a poor prognosis
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