Histological Damage of Colonic Epithelium is Associated with Clinical Severity and Outcome in Colectomized Critically Ill Patients

Background Severe intestinal mucosal damage and organ failure has been associated in experimental models. Our purpose was to determine whether there is any association between histopathological findings and postoperative mortality among ICU patients undergoing emergency colectomies for various illne...

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Published in:	World journal of surgery Vol. 38; no. 5; pp. 1211 - 1216
Main Authors:	Sipola, S., Ala-Kokko, T. I., Laurila, J. J., Vakkala, M., Ohtonen, P., Saarnio, J., Karttunen, T. J., Syrjälä, H.
Format:	Journal Article
Language:	English
Published:	Boston Springer US 01-05-2014 Springer Nature B.V
Subjects:	Abdominal Surgery Aged Blood Lactate Level Cardiac Surgery Case-Control Studies Colectomy Colon - pathology Colon Wall Critical Illness Female General Surgery Humans Intestinal Mucosa - pathology Male Medicine Medicine & Public Health Middle Aged Neutrophil Infiltration Retrospective Studies Sequential Organ Failure Assessment Sequential Organ Failure Assessment Score Severity of Illness Index Surgery Thoracic Surgery Treatment Outcome Vascular Surgery Colon Wall Blood Lactate Level Neutrophil Infiltration Sequential Organ Failure Assessment Score Sequential Organ Failure Assessment
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Summary:	Background Severe intestinal mucosal damage and organ failure has been associated in experimental models. Our purpose was to determine whether there is any association between histopathological findings and postoperative mortality among ICU patients undergoing emergency colectomies for various illnesses. Methods In a retrospective case control study, total colectomy specimens from 50 patients in a mixed ICU were analysed: 18 had sepsis, 11 vascular operations, and 21 Clostridium difficile colitis. Overall thickness, the width of epithelial defects, and presence of cryptal damage were assessed. Extent of necrosis and amount of neutrophils were separately evaluated in the layers of the colonic wall. Clinical features, including sequential organ failure assessment (SOFA) scores and survival, were registered. Results The histopathological findings for the three clinical entities were similar, except for the abundance of characteristic pseudomembranes in the Clostridium group. Mucosal height (maximum) showed a negative correlation with SOFA score on admission ( ρ = −0.296, P = 0.037), and with preoperative blood lactate level ( ρ = −0.316; P = 0.027). The nonsurvivors had wider enterocyte defects (60 vs. 40.8, P = 0.002) and more severe crypt damage (61 vs. 27 %; P = 0.024) than the survivors. Conclusions The histopathological damage involves all layers of the colon wall among ICU patients being largely similar in sepsis, C. difficile infection, and ischemia after vascular operations. Mucosal epithelial damage is associated with clinical severity of the illness and mortality.
Bibliography:	T. J. Karttunen and H. Syrjälä have contributed equally to this study. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0364-2313 1432-2323
DOI:	10.1007/s00268-013-2388-8