Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Critical Care
Published in: Critical Care 4/2012

Open Access 01-08-2012 | Research

Prognostic impact of fecal pH in critically ill patients

Authors: Akinori Osuka, Kentaro Shimizu, Hiroshi Ogura, Osamu Tasaki, Toshimitsu Hamasaki, Takashi Asahara, Koji Nomoto, Masami Morotomi, Yasuyuki Kuwagata, Takeshi Shimazu

Published in: Critical Care | Issue 4/2012

Login to get access

Abstract

Introduction

We have reported that altered gut flora is associated with septic complications and eventual death in critically ill patients with systemic inflammatory response syndrome. It is unclear how fecal pH affects these patients. We sought to determine whether fecal pH can be used as an assessment tool for the clinical course of critically ill patients.

Methods

Four hundred ninety-one fecal samples were collected from 138 patients who were admitted to the Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, Japan. These patients were treated in the intensive care unit for more than 2 days. Fecal pH, fecal organic acids, and fecal bacteria counts were measured and compared by survived group and nonsurvived group, or nonbacteremia group and bacteremia group. Logistic regression was used to estimate relations between fecal pH, age, sex, or APACHE II score and mortality, and incidence of bacteremia. Differences in fecal organic acids or fecal bacteria counts among acidic, neutral, and alkaline feces were analyzed.

Results

The increase of fecal pH 6.6 was significantly associated with the increased mortality (odds ratio, 2.46; 95% confidence interval, 1.25 to 4.82) or incidence of bacteremia (3.25; 1.67 to 6.30). Total organic acid was increased in acidic feces and decreased in alkaline feces. Lactic acid, succinic acid, and formic acid were the main contributors to acidity in acidic feces. In alkaline feces, acetic acid was significantly decreased. Propionic acid was markedly decreased in both acidic and alkaline feces compared with neutral feces. No differences were noted among the groups in bacterial counts.

Conclusions

The data presented here demonstrate that the fecal pH range that extended beyond the normal range was associated with the clinical course and prognosis of critically ill patients.
Appendix
Available only for authorised users
Literature
1.
Carrico CJ, Meakins JL, Marshall JC, Fry D, Maier RV: Multiple-organ-failure syndrome. Arch Surg. 1986, 121: 196-208. 10.1001/archsurg.1986.01400020082010.PubMedCrossRef
2.
Clark JA, Coopersmith CM: Intestinal crosstalk: a new paradigm for understanding the gut as the "motor" of critical illness. Shock. 2007, 28: 384-393. 10.1097/shk.0b013e31805569df.PubMedPubMedCentralCrossRef
3.
Shimizu K, Ogura H, Goto M, Asahara T, Nomoto K, Morotomi M, Yoshiya K, Matsushima A, Sumi Y, Kuwagata Y, Tanaka H, Shimazu T, Sugimoto H: Altered gut flora and environment in patients with severe SIRS. J Trauma. 2006, 60: 126-133. 10.1097/01.ta.0000197374.99755.fe.PubMedCrossRef
4.
Shimizu K, Ogura H, Asahara T, Nomoto K, Morotomi M, Nakahori Y, Osuka A, Yamano S, Goto M, Matsushima A, Tasaki O, Kueagata Y, Sugimoto H: Gastrointestinal dysmotility is associated with altered gut flora and septic mortality in patients with severe systemic inflammatory response syndrome: a preliminary study. Neurogastroenterol Motil. 2011, 23: 330-e157. 10.1111/j.1365-2982.2010.01653.x.PubMedCrossRef
5.
Fallingborg J: Intraluminal pH of the human gastrointestinal tract. Danish Med Bull. 1999, 46: 183-196.PubMed
6.
Fallingborg J, Christensen LA, Ingeman-Nielsen M, Jacobsen BA, Abildgaard K, Rasmussen HH: pH-profile and regional transit times of the normal gut measured by a radiotelemetry device. Aliment Pharmacol Ther. 1989, 3: 605-613.PubMedCrossRef
7.
Bown RL, Gibson JA, Sladen GE, Hicks B, Dawson AM: Effects of lactulose and other laxatives on ileal and colonic pH as measured by a radiotelemetry device. Gut. 1974, 15: 999-1004. 10.1136/gut.15.12.999.PubMedPubMedCentralCrossRef
8.
Kikuchi H, Yajima T: Correlation between water-holding capacity of different types of cellulose in vitro and gastrointestinal retention time in vivo of rats. J Sci Food Agric. 1992, 60: 139-146. 10.1002/jsfa.2740600202.CrossRef
9.
Azuma R, Suto T: Validity of transfer of the taxonomical position of Corynebacterium pseudopyogenes from genus Corynebacterium to genus Actinomyces. Culture Collections of Microorganisms: Proceedings of the First International Conference on Culture Collections. Edited by: lizuka H, Hasegawa T. 1970, Tokyo: University of Tokyo Press, 493-505.
10.
Tanaka R, Mutai M: Improved medium for selective isolation and enumeration of Bifidobacterium. Appl Environ Microbiol. 1980, 40: 866-869.PubMedPubMedCentral
11.
12.
Horan TC, Andrus M, Dudeck MA: CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008, 36: 309-332. 10.1016/j.ajic.2008.03.002.PubMedCrossRef
13.
Hassoun HT, Kone BC, Mercer DW, Moody FG, Weisbrodt NW, Moore FA: Post-injury multiple organ failure: the role of the gut. Shock. 2001, 15: 1-10.PubMedCrossRef
14.
Fink MP: Intestinal epithelial hyperpermeability: update on the pathogenesis of gut mucosal barrier dysfunction in critical illness. Curr Opin Crit Care. 2003, 9: 143-151. 10.1097/00075198-200304000-00011.PubMedCrossRef
15.
Han X, Fink MP, Yang R, Delude RL: Increased iNOS activity is essential for intestinal epithelial tight junction dysfunction in endotoxemic mice. Shock. 2004, 21: 261-270. 10.1097/01.shk.0000112346.38599.10.PubMedCrossRef
16.
Fink MP, Delude RL: Epithelial barrier dysfunction: a unifying theme to explain the pathogenesis of multiple organ dysfunction at the cellular level. Crit Care Clin. 2005, 21: 177-196. 10.1016/j.ccc.2005.01.005.PubMedCrossRef
17.
Bailey MT, Engler H, Sheridan JF: Stress induces the translocation of cutaneous and gastrointestinal microflora to secondary lymphoid organs of C57BL/6 mice. J Neuroimmunol. 2006, 171: 29-37. 10.1016/j.jneuroim.2005.09.008.PubMedCrossRef
18.
Nugent SG, Kumar D, Rampton DS, Evans DF: Intestinal luminal pH in inflammatory bowel disease: possible determinants and implications for therapy with aminosalicylates and other drugs. Gut. 2001, 48: 571-577. 10.1136/gut.48.4.571.PubMedPubMedCentralCrossRef
19.
20.
Mohan R, Koebnick C, Schildt J, Mueller M, Radke M, Blaut M: Effects of Bifidobacterium lactis Bb12 supplementation on body weight, fecal pH, acetate, lactate, calprotectin, and IgA in preterm infants. Pediatr Res. 2008, 64: 418-422. 10.1203/PDR.0b013e318181b7fa.PubMedCrossRef
21.
Marteau P, Pochart P, Flourie B, Pellier P, Santos L, Desjeux JF, Rambaud JC: Effect of chronic ingestion of a fermented dairy product containing Lactobacillus acidophilus and Bifidobacterium bifidum on metabolic activities of the colonic flora in humans. Am J Clin Nutr. 1990, 52: 685-688.PubMed
22.
Guimber D, Bourgois B, Beghin L, Neuville S, Pernes P, Ben Amor K, Goedhart A, Sijben J, Knol J, Gottrand F: Effect of multifibre mixture with prebiotic components on bifidobacteria and stool pH in tube-fed children. Br J Nutr. 2010, 104: 1514-1522. 10.1017/S0007114510002461.PubMedCrossRef
23.
Junko W: Carbohydrate fermentation in the colon. J Intest Microbiol. 2005, 19: 169-177.
24.
Fine KD, Schiller LR: AGA technical review on the evaluation and management of chronic diarrhea. Gastroenterology. 1999, 116: 1464-1486. 10.1016/S0016-5085(99)70513-5.PubMedCrossRef
25.
Eherer AJ, Fordtran JS: Fecal osmotic gap and pH in experimental diarrhea of various causes. Gastroenterology. 1992, 103: 545-551.PubMed
26.
Heyman MB: Lactose intolerance in infants, children, and adolescents. Pediatrics. 2006, 118: 1279-1286. 10.1542/peds.2006-1721.PubMedCrossRef
Metadata
Title
Prognostic impact of fecal pH in critically ill patients
Authors
Akinori Osuka
Kentaro Shimizu
Hiroshi Ogura
Osamu Tasaki
Toshimitsu Hamasaki
Takashi Asahara
Koji Nomoto
Masami Morotomi
Yasuyuki Kuwagata
Takeshi Shimazu
Publication date
01-08-2012
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2012
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc11413

Other articles of this Issue 4/2012

Critical Care 4/2012 Go to the issue

Editorial

The Barcelona Declaration from the World Alliance against Antibiotic Resistance: engagement of intensivists

Research

Depletion of neutrophil extracellular traps in vivo results in hypersusceptibility to polymicrobial sepsis in mice

Research

Kidney function decline after a non-dialysis-requiring acute kidney injury is associated with higher long-term mortality in critically ill survivors

Research

Effects of endotoxin on lactate metabolism in humans

Research

Continuous venovenous hemodialysis with regional citrate anticoagulation in patients with liver failure: a prospective observational study

Letter

Recruitment maneuver after apnea test or continuous positive airway pressure apnea test?