Effect Of The Severity Of Traumatic Brain Injury On Intestinal Barrier Function And Gastrointestinal Function

Objective To analyze the time trend of the overall level of serological indexes related to intestinal barrier function in patients with different severity of TBI(Traumatic Brain Injury),so as to clarify the effect of TBI severity on intestinal barrier function.At the same time,the effects of TBI severity and course of disease on gastrointestinal function were discussed,so as to clearly judge the changes of intestinal barrier function and gastrointestinal function after TBI,and provide reliable clinical basis for early implementation of timely and effective intervention measures.Methods TBI patients admitted to the Department of Critical Care Medicine of Taizhou People ’s Hospital from January 2022 to January 2023 were collected.Baseline data within 24 hours of admission were included : name,gender,age,time and cause of injury,underlying disease,GCS score,etc.TBI patients were divided into three groups according to Glasgow Coma Scale(GCS)score: mild group(GCS 13-15),moderate group(GCS 9-12)and severe group(GCS 3-8).Venous blood samples were collected at 1 day,3 days,and 7 days after admission.The levels of D-lactic acid,DAO(diamine oxidase)and endotoxin were measured by corresponding detection methods to evaluate the degree of intestinal barrier damage in TBI patients.At the same time,the levels of CRP(C-reactive protein)and PCT(procalcitonin)were collected at 1 day,3 days,and 7 days.All patients were evaluated for AGI(Acute Gastrointestinal Injury)on day 1,3,and 7,and SOFA scores were performed on day 7.SPSS 26.0 statistical software was used for data analysis to compare the differences in intestinal barrier indicators,CRP,AGI,and SOFA scores on the 7th day among the three groups.Spearman correlation analysis was used to analyze the correlation between CRP,SOFA score on day 7 and intestinal barrier indexes.P < 0.05 was considered statistically significant.Results 1 A total of 101 patients were included,35 in the mild group,33 in the moderate group and 33 in the severe group.The baseline data of the three groups were compared.The results showed that there was a statistically significant difference in age among the three groups,P = 0.046,but there was no statistical difference in gender,cause of injury,underlying diseases,P > 0.05.2 Comparison of serum D-lactic acid,DAO and endotoxin levels among the three groups On the 1st,3rd and 7th day after admission,the differences of serum D-lactic acid,DAO and endotoxin levels among the three groups of mild,moderate and severe TBI were statistically significant at different time points.The average level of each index in the severe group was higher than that in the mild group and the moderate group,and the average level of each index in the moderate group was higher than that in the mild group.In addition,the changes of serum D-lactic acid,DAO and endotoxin levels in mild,moderate and severe groups were the same,which gradually increased with time,peaked on the third day and decreased slightly on the seventh day.3 The occurrence of AGI in three groups of TBI patients and its correlation with the severity of brain injury On the 1st,3rd and 7th day after admission,AGI occurred in 46.6%,71.3% and 56.7% of patients with mild,moderate and severe TBI,respectively.The more severe the brain injury,the higher the proportion of high-grade AGI.4 Comparison of inflammatory markers among the three groups and their correlation with intestinal barrier markers On the 1st,3rd and 7th day of admission,there were statistically significant differences in the levels of inflammatory indicators among TBI patients in the mild,moderate and severe groups.The level of severe group was higher than that of mild group and moderate group,and that of moderate group was higher than that of mild group.In addition,the inflammatory indicators gradually increased over time,peaked on the third day,and decreased slightly on the seventh day.Correlation analysis showed that the inflammatory indexes on the 1st,3rd and 7th day after TBI were positively correlated with the intestinal barrier related indexes at the same time point.Among them,there was a significant positive correlation between Dlactic acid and PCT on day 1 and between D-lactic acid and PCT on day 7,r = 0.558 and 0.802,P < 0.0001.5 Logistic regression analysis of intestinal barrier related indexes and inflammatory indexes at different time points The collinearity and multivariate analysis of intestinal barrier indexes and inflammatory indexes on the 1st,3rd and 7th day of admission showed that DAO,endotoxin on the 3rd day and PCT on the 7th day were independently correlated with the severity of brain injury in TBI patients.6 Comparison of SOFA scores on the 7th day among the three groups and correlation with intestinal barrier indexes SOFA score on the 7th day: mild group(3.18 ± 2.44)vs moderate group(5.52 ± 3.54)vs severe group(9.24 ± 4.21),P < 0.05,with statistical difference.Correlation analysis showed that the levels of D-lactic acid,DAO and endotoxin were positively correlated with SOFA score,P < 0.05.7 Comparison of hospitalization time among the three groups The more severe the brain injury,the longer the hospitalization time(mild group 15.11 ± 16.68 vs moderate group 21.00 ± 17.69 vs severe group 21.03 ± 14.39),P = 0.297.Conclusion 1 The more severe the brain injury in TBI patients,the more severe the intestinal barrier function damage.The levels of D-lactic acid,DAO and endotoxin reached the peak on the third day and decreased slightly on the seventh day.2 The severity of brain injury was positively correlated with the severity of AGI.3 The more severe the brain injury in patients with TBI,the higher the level of inflammatory markers,which peaked on the third day and decreased slightly on the seventh day.The levels of inflammatory markers at different time points were positively correlated with the levels of intestinal barrier markers.4 The more severe the brain injury in TBI patients,the higher the SOFA score on the 7th day,and the SOFA score was positively correlated with the level of intestinal barrier index.5 The more severe the brain injury in TBI patients,the longer the hospitalization time.