Preoperative Intra-abdominal Sepsis, Not Penetrating Behavior Itself, Is Associated With Worse Postoperative Outcome After Bowel Resection for Crohn Disease

Zhang, Tenghui; Yang, Jianbo; Ding, Chao; Li, Yang; Gu, Lili; Yao, Wei; Cao, Lei; Gong, Jianfeng; Zhu, Weiming; Li, Ning; Li, Jieshou

doi:10.1097/md.0000000000001987

Cited by 10 publications

(8 citation statements)

References 17 publications

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“…A preoperative lag allowed for amelioration of patient conditions – reducing the inflammatory environment [58-60], increasing serum albumin [59, 60], weaning or suspending CST therapy [57, 59], and treating abscesses [59, 60] – as opposed to patients operated on immediately [58, 59]. These properties have also been attributed to nutritional support, both enteral and parenteral, by other authors [44, 47, 48, 50, 52-54, 69-72]. Also, in one of the reviewed studies [59], going straight to surgery (non-EEN patients) was an independent risk factor for anastomotic leaks and/or intra-abdominal abscesses.…”

Section: Discussionmentioning

confidence: 99%

“…Although EN is not indicated as treatment for CD in adults by Chinese guidelines [62], eight of the excluded studies originated from China. The article by Li et al [57] was produced by the same institution as that of seven [46-48, 50-52, 54] of the previous 8 studies, the latter being well known for its publications regarding this topic [31, 34, 63]. One of the excluded articles is Japanese [45].…”

Section: Discussionmentioning

confidence: 99%

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Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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Background and Aim: Enteral nutrition (EN) is applicable to adult Crohn’s disease (CD) in treating malnutrition and in inducing remission – here as a less effective alternative than corticosteroids. The purpose of this review is to determine whether preoperative EN impacts postoperative complications of adult CD, either by means of nutritional or therapeutic effects. Summary: A systematic review of English written full-text research articles published between January 1990 and November 2017, including adult patients undergoing abdominal surgery for complicated CD after EN, was performed. Four studies out of 22 were selected, all of which institutional, retrospective, case-control cohorts, one classified as “good quality” and three as “poor quality,” as rated by the Newcastle-Ottawa Scale. The application of inclusion and exclusion criteria resulted in a non-intentional absence of studies referring to supplemental EN among those reviewed. The reduced number of heterogeneous eligible studies impeded meta-analysis. In all studies, exclusive EN (EEN) was used and well tolerated, allowing to defer or even avoid surgery altogether, improving patients’ global state. The two studies with the greatest number of patients found preoperative EEN to be an independent factor against infectious and non-infectious complications in 219 patients and against anastomotic leaks or abscesses in 38 patients. Also, in univariate analysis, EEN was found to increase preoperative immunosuppressant-free intervals and to protect against anastomotic dehiscences, intra-abdominal abscesses, surgical wound infections, ileus, stomas, and reoperations in the largest study; in another study it was related to fewer intra-abdominal septic complications. Key Messages: All reviewed studies are retrospective and, consequently, of limited relevance. Nonetheless, all of them call the attention of the scientific community to the potential benefits of preoperative EEN on postoperative outcomes in adult CD, calling for prospective multi-institutional studies and randomized controlled trials.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Rocha

Bessa

Lago

et al. 2018

GE Port J Gastroenterol

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“…The preoperative PLR and NLR are simply, inexpensively and widely available markers to reflect systemic inflammation status [ 10 , 17 , 18 ]. Several recent studies have demonstrated that preoperative inflammation state is associated with a worse postoperative outcome after surgery [ 19 – 21 ]. Our study showed that both preoperative PLR and NLR have a positive correlation with the PPCs particularly pneumonia and atelectasis in NSCLC patients undergoing radical surgery.…”

Section: Discussionmentioning

confidence: 99%

Preoperative platelet to lymphocyte and neutrophil to lymphocyte ratios are independent prognostic factors for patients undergoing lung cancer radical surgery: A single institutional cohort study

et al. 2016

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BackgroundThe aim of this study was to assess the prognostic value for NSCLC patients who were scheduled to receive lung cancer radical resection.MethodsIn this cohort study (Dec.2014-Feb.2016), patients with non-small cell lung cancer (NSCLC) who underwent radical lung cancer thoracotomy were enrolled and accessed at postoperative complications, one-year overall survival (OS) and relapse-free survival (RFS). The preoperative PLR and NLR of all patients were calculated based on preoperative complete blood counts. Univariate and multivariate Cox regression analyses were performed to determine the associations of PLR and NLR with OS and RFS.ResultsA total of 174 NSCLC patients were studied. The results indicated that both high PLR (>148.6) and NLR (>2.9) were related to a high rate of postoperative pulmonary complications significantly (49.3%vs.29.1%, P = 0.007; 50.7% vs. 28.6%, P = 0.003). Moreover, NSCLC patients with a high PLR level (> 148.6) was significantly associated with a lower one-year OS (90.3% vs. 77.5%, P = 0.034).ConclusionsPreoperative PLR and NLR were good prognostic factors for postoperative pulmonary complications and OS in NSCLC patients undergoing radical lung cancer surgery. Thus, blood PLR and NLR would be helpful as a prognostic tool before radical lung cancer surgery.

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“…In the United States, the incidence of severe sepsis is estimated to be 300 cases per 100,000 of the population, and the age-adjusted mortality caused by sepsis is >60 per 100,000 (6). Sepsis is associated with gastrointestinal tract dysfunction, manifesting as dysfunction in gastrointestinal motility, nutritional absorption and the intestinal immunological barrier, which ultimately results in intestinal mucosa atrophy, dysbacteriosis and enterogenic infection, thereby causing or aggravating dysfunction in other organs (7,8). Hiltebrand et al (9) reported that stomach blood flow was reduced by 55% in a sepsis model in pigs.…”

Section: Introductionmentioning

confidence: 99%

Ghrelin regulates sepsis‑induced rat acute gastric injury

Lin

Guo

et al. 2019

Mol Med Report

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Ghrelin, a peptide expressed in the gastric mucosa, has an essential role in sustaining the normal function of the digestive system. Sepsis is one of the primary causes of mortality in intensive care units and can lead to multiple organ dysfunction, especially in the gastrointestinal system. The aim of the present study was to explore the effect of ghrelin on gastric blood flow in a rat model of sepsis, as well as the effect of ghrelin on the expression of the apoptotic markers, B-cell lymphoma 2 (Bcl-2) and Bcl-2-associated X (Bax), in gastric tissues. The sepsis model was established using cecal ligation and puncture (CLP). The expression levels of apoptosis-related factors in gastric epithelial cell were determined by immunohistochemistry, reverse transcription quantitative-PCR and western blotting. Collectively, the present results suggested that ghrelin administration attenuated sepsis symptoms induced by CLP. Blood flow in the stomach greater curvature was significantly higher in the CLP-induced sepsis group rats (284.3±95.7 perfusion units) compared with the sham operation group (317.8±5.2 perfusion units; P<0.05), whereas there was no difference between the CLP group treated with ghrelin (377.8±99.0 perfusion units) and the sham rats. Ghrelin administration also reduced the secretion of pro-inflammatory cytokines compared with the CLP-induced sepsis group rats. In addition, CLP significantly reduced the expression of Bcl-2 and enhanced the expression of the pro-apoptotic proteins, Bax and cleaved caspase-3; whereas, ghrelin application reversed the effects of CLP on these apoptosis-associated proteins. In conclusion, the present study revealed that ghrelin has the ability to increase blood flow in the gastrointestinal tract in a sepsis model and can also regulate the expressions of apoptosis-associated factors in gastric tissues. These results suggest that ghrelin could be a novel treatment for sepsis-induced gastric injury.

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Preoperative Intra-abdominal Sepsis, Not Penetrating Behavior Itself, Is Associated With Worse Postoperative Outcome After Bowel Resection for Crohn Disease

Cited by 10 publications

References 17 publications

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Preoperative Enteral Nutrition and Surgical Outcomes in Adults with Crohn’s Disease: A Systematic Review

Preoperative platelet to lymphocyte and neutrophil to lymphocyte ratios are independent prognostic factors for patients undergoing lung cancer radical surgery: A single institutional cohort study

Ghrelin regulates sepsis‑induced rat acute gastric injury

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