Early increase in intestinal permeability in patients with severe acute pancreatitis: Correlation with endotoxemia, organ failure, and mortality

Sepsis accounts for 80% of deaths from acute pancreatitis. This study aimed to investigate early changes in intestinal permeability in patients with a cute pancreatitis, and to correlate these changes with subsequent disease s everity and endotoxemia. The renal excretion of enterally administered poly ethylene glycol (PEG) 3350 and PEG 400 was measured within 72 hours of onse t of acute pancreatitis to determine intestinal permeability. Severity was assessed on the basis of APACHE II: scores and C-reactive protein measureme nts. Serum endotoxin and antiendotoxin antibodies were measured on admissio n. Eight-five patients with acute pancreatitis (mild in 56, severe in 29) a nd 25 healthy control subjects were studied. Urinary excretion of PEG 3350 (median) was significantly greater in patients who had severe attacks (0.61 %) compared to those with mild disease (0.09%) and health control subjects (0.12%) (P <0.0001), as was the permeability index (PEG 3350/400 excretion) (P <0.00001). The permeability index was significantly greater in patients who subsequently developed multiple organ system failure and/or died compa red nth other severe cases (0.16 vs. 0.04) (P = 0.0005). The excretion of P EG 3350 correlated strongly with endotoxemia (r = 0.8, P = 0.002). Early in creased intestinal permeability may play an important role in the pathophys iology of severe acute pancreatitis. Therapies that aim to restore intestin al barrier function mag improve outcome.