Is compromised intestinal barrier integrity responsible for the poor prognosis in critically ill patients with pre-existing hyperglycemia?

• Published in: Diabetology and metabolic syndrome 2022-11, Vol.14 (1), p.1-172, Article 172
• Main Authors: Wang, Yi-Feng, Liang, Feng-Ming, Liu, Min, Ding, Li-Cheng, Hui, Jiao-Jie, Xu, Hong-Yang, Liu, Li-Jun
• Format: Article
• Language: English
• Subjects: Bacteria; Biomarkers; Blood sugar; Comparative analysis; Creatinine; Critical illness; Diabetes; Disease; Glycosylated hemoglobin; Hemoglobin; Hospitals; Hyperglycemia; Illnesses; Intestinal barrier; Intestine; Lactic acid; Leukocytes (neutrophilic); Lipopolysaccharides; Medical prognosis; Medical research; Medicine, Experimental; Metabolites; Mortality; Nitrogen; Normal distribution; Patients; Prognosis; Regression analysis; Risk factors; Statistical analysis; United Kingdom
• ISSN: 1758-5996; 1758-5996
• DOI: 10.1186/s13098-022-00943-5

Background Compromised intestinal barrier integrity can be independently driven by hyperglycemia, and both hyperglycemia and intestinal barrier injury are associated with poor prognosis in critical illness. This study investigated the intestinal barrier biomarkers in critically ill patients, to explore the role of compromised intestinal barrier integrity on the prognosis of critically ill patients with pre-existing hyperglycemia. Methods This was a retrospective observational study. The relationships between intestinal barrier biomarkers and glycated hemoglobin A1c (HbA1c), fasting blood glucose (FBG), indicators of clinical characteristics, disease severity, and prognosis in critically ill patients were investigated. Then the metrics mentioned above were compared between survivors and non-survivors, the risk factors of 90-day mortality were investigated by logistic regression analysis. Further, patients were divided into HbA1c < 6.5% Group and HbA1c [greater than or equal to] 6.5% Group, metrics mentioned above were compared between these two groups. Results A total of 109 patients with critical illness were included in the study. D-lactate and lipopolysaccharide (LPS) were associated with sequential organ failure assessment (SOFA) score and 90-day mortality. LPS was an independent risk factor of 90-day mortality. DAO, NEU (neutrophil) proportion, temperature, lactate were lower in HbA1c [greater than or equal to] 6.5% Group while D-lactate, LPS, indicators of disease severity and prognosis showed no statistical difference between HbA1c < 6.5% Group and HbA1c [greater than or equal to] 6.5% Group. Conclusions Intestinal barrier integrity is associated with the disease severity and prognosis in critical illness. Compromised intestinal barrier integrity might be responsible for the poor prognosis in critically ill patients with pre-existing hyperglycemia. Keywords: Intestinal barrier, Hyperglycemia, Critical illness, Prognosis