Evaluation of gut-blood barrier dysfunction in various models of trauma, hemorrhagic shock, and burn injury

Wrba, Lisa; Palmer, Annette; Braun, Christian; Huber‐Lang, Markus

doi:10.1097/ta.0000000000001654

Cited by 17 publications

(6 citation statements)

References 84 publications

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“…In this study, the correlation of various characteristics and POI was analysed by regression analysis. Multivariate analysis indicated that intraoperative blood loss≥200 ml (P=0.013) was significantly (39); third, through the alteration of the immune system, intraoperative blood loss can also increase the relative abundance of opportunistic pathogenic bacterial species in the intestinal tract (40). Given the relationship between intraoperative blood loss and POI, surgeons should take measures to reduce blood loss, such as identifying and managing patients at risk of high blood loss and improving techniques (carefully separating blood vessels, avoiding bleeding in a timely manner, hepatic portal occlusion et al) to control bleeding during surgery (41).…”

Section: Discussionmentioning

confidence: 99%

Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

et al. 2022

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ObjectiveTo investigate the impact of postoperative infectious complications (POI) on the long-term outcomes of patients with colorectal cancer liver metastasis (CRLM) after simultaneous resection of colorectal cancer and liver metastases.MethodsFour hundred seventy-nine CRLM patients receiving simultaneous resection between February 2010 and February 2018 at our hospital were enrolled. A 1:3 propensity score matching analysis (PSM) analysis was performed to balance covariates and avoid selection bias. After PSM, 90 patients were distributed to the POI group, and 233 patients were distributed to the no POI group. A log-rank test was performed to compare the progression-free survival (PFS) and overall survival (OS) data. A multivariate Cox regression model was employed to identify prognostic factors influencing OS and PFS. A value of two-sided P<0.05 was considered statistically significant.ResultsCompared to patients in the no POI group, patients in the POI group were more likely to have hepatic portal occlusion (78.9% vs. 66.3%, P=0.021), operation time ≥325 min (61.1% vs. 48.1%, P=0.026), and intraoperative blood loss ≥200 ml (81.1% vs. 67.6%, P=0.012). In multivariate analysis, intraoperative blood loss ≥200 ml (OR = 2.057, 95% CI: 1.165-3.634, P=0.013) was identified as the only independent risk factor for POI. Patients with POI had a worse PFS (P<0.001, median PFS: 7.5 vs. 12.7 months) and a worse OS (P=0.010, median OS: 38.8 vs. 59.0 months) than those without POI. After 1:3 PSM analysis, no differences in clinicopathologic parameters were detected between the POI group and the no POI group. Patients with POI had a worse PFS (P=0.013, median PFS: 7.5 vs. 11.1 months) and a worse OS (P=0.020, median OS: 38.8 vs. 59.0 months) than those without POI. Multivariate analysis showed that POI was an independent predictor for worse PFS (HR=1.410, 95% CI: 1.065-1.869, P=0.017) and worse OS (HR=1.682, 95% CI: 1.113-2.544, P=0.014).ConclusionsPOI can significantly worsen the long-term outcomes of CRLM patients receiving simultaneous resection of colorectal cancer and liver metastases and should be considered to improve postoperative management and make better treatment decisions for these patients.

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Section: Discussionmentioning

confidence: 99%

Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

et al. 2022

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“…An intact intestinal barrier serves as a crucial boundary separating the systemic circulation from the intestinal microbiome. When this barrier is compromised, it can lead to the translocation of bacteria and pathogen-associated molecular patterns (PAMPs) into the bloodstream or lymphatic system, thereby intensifying the immune response and promoting systemic inflammation (Wrba et al 2017 ). This phenomenon is commonly observed as a complication following injury, with profound systemic effects on both pro-inflammatory and anti-inflammatory immune responses, as well as organ perfusion and oxygenation.…”

Section: Barrier Failure Due To Traumamentioning

confidence: 99%

Trauma-toxicology: concepts, causes, complications

Barth,

Worek,

Steinritz

et al. 2023

Naunyn-Schmiedeberg's Arch Pharmacol

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Trauma and toxic substances are connected in several aspects. On the one hand, toxic substances can be the reason for traumatic injuries in the context of accidental or violent and criminal circumstances. Examples for the first scenario is the release of toxic gases, chemicals, and particles during house fires, and for the second scenario, the use of chemical or biological weapons in the context of terroristic activities. Toxic substances can cause or enhance severe, life-threatening trauma, as described in this review for various chemical warfare, by inducing a tissue trauma accompanied by break down of important barriers in the body, such as the blood-air or the blood-gut barriers. This in turn initiates a “vicious circle” as the contribution of inflammatory responses to the traumatic damage enhances the macro- and micro-barrier breakdown and often results in fatal outcome. The development of sophisticated methods for detection and identification of toxic substances as well as the special treatment of the intoxicated trauma patient is summarized in this review. Moreover, some highly toxic substances, such as the protein toxins from the pathogenic bacterium Clostridioides (C.) difficile, cause severe post-traumatic complications which significantly worsens the outcome of hospitalized patients, in particular in multiply injured trauma patients. Therefore, novel pharmacological options for the treatment of such patients are necessarily needed and one promising strategy might be the neutralization of the toxins that cause the disease. This review summarizes recent findings on the molecular and cellular mechanisms of toxic chemicals and bacterial toxins that contribute to barrier breakdown in the human body as wells pharmacological options for treatment, in particular in the context of intoxicated trauma patients. “trauma-toxicology” comprises concepts regrading basic research, development of novel pharmacological/therapeutic options and clinical aspects in the complex interplay and “vicious circle” of severe tissue trauma, barrier breakdown, pathogen and toxin exposure, tissue damage, and subsequent clinical complications.

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“…After burn, cytokines, chemokines and danger-associated molecular patterns (DAMPs) emanate from the injured tissue and travel to a number of organs, including the gut [ 20 ]. This, combined with post-burn induced intestinal ischemia [ 21 ], causes intestinal damage and a breach of the intestinal epithelial barrier, allowing bacteria and their products to enter the lymphatic system and ultimately the blood [ 22 - 25 ]. A breakdown of the gut barrier results in inflammation and damage to distant organs, including the liver, lung and brain ( Figure 1 ).…”

Section: The Gut As a Driver Of Systemic Inflammation After Burn Injurymentioning

confidence: 99%

Aging, Cutaneous Burn Injury and Multi-Organ Complications: The Role of the Gut

McMahan

Boe

Walrath

et al. 2022

Adv Geriatr Med Res

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Advanced age escalates post-burn complications and older burn patients, and even those with relatively minor burns, have worse clinical outcomes after injury. While the mechanism(s) responsible for the compounding effects of age and burn injury have not been defined, in this viewpoint, we highlight the emerging data suggesting that age-mediated impairment of gut barrier integrity and dysbiosis of the fecal microbiome in older subjects may play a role in the heightened multi-organ responses seen in older patients. Studies aimed at exploring the contribution of intestinal dysfunction in age-related exacerbations of post-burn inflammatory responses could highlight novel therapeutic interventions that can be used to treat victims of burns and other traumatic injuries.

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Evaluation of gut-blood barrier dysfunction in various models of trauma, hemorrhagic shock, and burn injury

Cited by 17 publications

References 84 publications

Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

Impact of Postoperative Infectious Complications on Long-Term Outcomes for Patients Undergoing Simultaneous Resection for Colorectal Cancer Liver Metastases: A Propensity Score Matching Analysis

Trauma-toxicology: concepts, causes, complications

Aging, Cutaneous Burn Injury and Multi-Organ Complications: The Role of the Gut

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