Serum ghrelin and PYY enterohormones during acute critical illness: A prospective observational trial
Nutrition Clinique et Métabolisme(2016)
摘要
Introduction Gastrointestinal failure during critical illness is associated with decreased intake and limited tolerance to enteral feeding. Enterohormones like ghrelin and PYY could play a role in these dysfunctions. This study aimed at defining: – the time course of serum ghrelin and PYY during the first 5 days of stay; – correlations with limited tolerance to enteral feeding. Material and methods Thirty consecutive patients (age: 56.4 ± 16.4; BMI: 26.3 ± 4.5) and 10 fasting healthy volunteers (age: 34.1 ± 6.8; BMI: 23.1 ± 4.2) were included. In patients, blood was sampled for 5 consecutive days and once in the control group. Blood samples were immediately centrifuged at 3000 × g for 10 minutes at 4 °C. Ghrelin samples were acidified to pH 4 and then all samples were stored at –80 °C until processing. Ghrelin and PYY serum concentrations were measured using a commercial ELISA test. Enteral feeding intolerant patients were defined as patients with at least one episode of high gastric residual volume (u003e 250 mL) and/or diarrhea (u003e 200 mL of liquid stools/day). Comparisons between continuous variables were done using ANOVA and the Wilcoxon U -test as appropriated. Alpha error was set at 5%. Results The incidence of intolerance among patients was 41.4%. Mean gastric residual volume (millilitres) was higher in intolerant than in tolerant patients ( P P = 0.03) and than controls (53.5 pg/mL [17.5–191.7 pg/mL] vs. 6.4 pg/mL [0.35–18.1 pg/mL]; P = 0.02). Daily PYY serum concentration was higher in intolerant than in tolerant patients, specifically on days 2 (median (IQR): 103.2 pg/mL [23.2–193.6 pg/mL] vs. 16.9 pg/mL [3.9–54 pg/mL]; P = 0.02) and day 5 (103.2 pg/mL [23.2–193.6 pg/mL] vs. 16.9 pg/mL [3.9 to 54 pg/mL]; P = 0.02). Controls had a significantly higher serum ghrelin concentration than either tolerant patients (median (IQR): 1435.7 pg/mL [1335.5–1775.5 pg/mL] vs. 219.4 pg/mL [84–420.5 pg/mL]; P P = 0.004). Unexpectedly, serum ghrelin concentration was higher in intolerant compared to tolerant patients (median (IQR): 283.5 pg/mL [92–1002.5 pg/mL] vs. 219.4 pg/mL [84–420.5 pg/mL]; P = 0.02). No difference in serum ghrelin concentration between tolerant compared to intolerant patients was found from day 1 to day 5. Conclusions In critically ill patients, mean serum concentration of ghrelin and PYY significantly differ from that of healthy controls. These findings support a role of enterohormones in the critical illness-associated gastrointestinal failure.
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