Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 21, 2016; 22(11): 3275-3284
Published online Mar 21, 2016. doi: 10.3748/wjg.v22.i11.3275
Dual-sugar tests of small intestinal permeability are poor predictors of bacterial infections and mortality in cirrhosis: A prospective study
Anika Vogt, Philipp A Reuken, Sven Stengel, Andreas Stallmach, Tony Bruns
Anika Vogt, Philipp A Reuken, Sven Stengel, Andreas Stallmach, Tony Bruns, Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
Philipp A Reuken, Andreas Stallmach, Tony Bruns, Center for Sepsis Control and Care, Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany
Author contributions: Stallmach A and Bruns T designed and supervised the study; Vogt A and Reuken PA recruited patients, collected specimens, performed measurements and analyzed clinical data; Vogt A, Stengel S and Bruns T performed statistical analysis, interpreted the results, conducted literature search and wrote the manuscript; Stengel S, Stallmach A and Reuken PA critically revised the manuscript for important intellectual content; all authors read and approved the final version of the manuscript.
Supported by the Federal Ministry of Education and Research (BMBF) Germany (FKZ: 01 E0 1002) (in part).
Institutional review board statement: The study protocol and informed consent forms were approved by the Internal Review Board (Ethics Committee of the Friedrich Schiller University Jena, 2931-09/10).
Informed consent statement: Written informed consent was obtained by all patients.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest with respect to this manuscript.
Data sharing statement: The data are provided within this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Tony Bruns, MD, Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Erlanger Allee 101, 07747 Jena, Germany. tony.bruns@med.uni-jena.de
Telephone: +49-3641-9324221 Fax: +49-3641-9324222
Received: July 1, 2015
Peer-review started: July 4, 2015
First decision: September 29, 2015
Revised: October 20, 2015
Accepted: December 30, 2015
Article in press: December 30, 2015
Published online: March 21, 2016
Processing time: 257 Days and 7.7 Hours
Core Tip

Core tip: Increased intestinal permeability (IP) is a frequent phenomenon in patients with cirrhosis and has been linked to pathological bacterial translocation, bacterial infections and mortality in retrospective studies. In this prospective study on 46 patients with cirrhosis we show that increased small-bowel IP, quantified using the lactulose/mannitol test, is frequently observed and correlates with inflammation and Child-Pugh stage. Although a higher IP index indicated an increased risk for developing spontaneous bacterial peritonitis, it failed to predict the pre-defined endpoints infection-free and overall survival. In contrast, the model for end-stage liver disease and Child-Pugh score, the presence of ascites, and higher serum levels of interleukin-6 or intestinal fatty-acid binding protein were significant univariate predictors of infection-free survival. Thus, the high prevalence of pathological test results in advanced cirrhosis and the lack of association with mortality limit the use of dual-sugar tests as tool for risk stratification in clinical practice.