Dual-sugar tests of small intestinal permeability are poor predictors of bacterial infections and mortality in cirrhosis: A prospective study

Table 1 Patients characteristics at baseline (n = 46) n (%)

	Median (range)/frequency
Age (yr)	59 (42-81)
Male sex	28 (61)
Etiology
Alcoholic liver disease	33 (72)
Viral hepatitis	6 (13)
Other	7 (15)
Comorbidity
Hepatocellular carcinoma	9 (20)
Diabetes	10 (22)
Child-Pugh stage
A	6 (13)
B	19 (41)
C	21 (46)
Ascites	31 (67)
Child-Pugh score	9 (5-14)
MELD score	15 (6-27)
Bilirubin (µmol/L)	61.4 (4-429)
International normalized ratio	1.4 (0.9-2.6)
Creatinine (µmol/L)	114 (43-533)
CrP (mg/L)	23.1 (2-112.4)
Albumin (g/L)	28 (17-51)
Sodium (mmol/L)	135 (125-144)
White blood cells (Gpt/L)	6.3 (1.2-22.2)
Platelets (Gpt/L)	135 (29-442)
Alanine aminotransferase (µmol/L*s)	1.41 (0.33-20.86)
Aspartate aminotransferase (µmol/L*s)	1.6 (0.4-8.8)
Medication
Non-selective beta blockers	19 (41)
Lactulose	21 (46)
Proton pump inhibitors	36 (78)
Terlipressin	1 (2)
Acetylsalicylic acid	5 (11)

Median and range or frequency and percent are shown.

Table 2 Nonparametric correlation of the intestinal permeability index with baseline laboratory data

	Spearman’s rho	P value
Age	-0.166	0.270
Child-Pugh score	0.484	0.0007
MELD score	0.282	0.060
Bilirubin	0.381	0.009
International normalized ratio	0.445	0.002
Creatinine	-0.214	0.154
Serum albumin	-0.339	0.021
Sodium	0.013	0.930
White blood cells	0.174	0.247
C-reactive protein	0.102	0.499
Platelets	0.049	0.748
Alanine aminotransferase	-0.063	0.686
Aspartate aminotransferase	0.347	0.041

Table 3 Parameters at baseline stratified for the development of hospitalization with infection within one year n (%)

	Without subsequent infection	With subsequent infection	P value
	(n = 27)	(n = 19)
Age (yr)	56 (42-78)	60 (44-81)	0.220
Male sex	17 (63)	11 (58)	0.770
Alcoholic liver disease	22 (81)	11 (58)	0.100
Diabetes	7 (26)	3 (16)	0.490
Child-Pugh stage
A	6 (22)	0	0.070
B	11 (41)	8 (42)
C	10 (37)	11 (58)
Ascites	14 (52)	17 (89)	0.010
Child-Pugh score	9 (5-13)	10 (7-14)	0.046
MELD	12 (6-27)	17 (9-25)	0.0008
CrP (mg/L)	16 (2-91)	17 (2-112)	0.720
Sodium (mmol/L)	136 (125-142)	136 (131-144)	0.970
White blood cells (Gpt/L)	6.1 (2.8-22.2)	6.5 (1.2-9.0)	0.860
Platelets (Gpt/L)	159 (42-442)	99 (29-163)	0.020
IP index	0.14 (0.03-0.52)	0.22 (0.02-0.045)	0.250
Pathological IP index	23 (85)	16 (84)	1.000
LBP (µg/L)	18 (7-75)	24 (7-75)	0.720
IL-6 (pg/mL)	37 (9-1791)	64 (5-1191)	0.360
I-FABP1 (pg/mL)	1161 (nd-8683)	4036 (1520-8061)	0.005

¹Serum IFABP levels were available from 36 patients. Median and range or frequency and percent are shown. ND: Not detected.

Table 4 Predictors of the time to bacterial infection or death n (%)

	Bacterial infection or death within 1 yr	Univariate hazard ratio (95%CI)	P value	Adjusted hazard ratio3 (95%CI)	P value
MELD score1
≤ 13	5/20 (25)	1.00 (reference)	0.003	1.00 (reference)	0.02
> 13	18/26 (69)	4.45 (1.64-12.07)		3.23 (1.18-8.83)
Child-Pugh
Score1
≤ 7	1/13 (8)	1.00 (reference)	0.010	Not included
> 7	22/33 (67)	13.63 (1.83-101.73)		(not significant)
Ascites1
No	2/15 (13)	1.00 (reference)	0.003	1.00 (reference)	0.01
Yes	21/31 (68)	9.01 (2.10-38.70)		6.95 (1.59-30.28)
IL-61
≤ 35 pg/mL	4/17 (24)	1.00 (reference)	0.010	Not included
> 35 pg/mL	19/29 (66)	3.87 (1.31-11.47)		(not significant)
I-FABP12
≤ 1300 pg/mL	1/13 (8)	1.00 (reference)	0.010	Not included
> 1300 pg/mL	16/23 (70)	13.85 (1.83-105.04)		(missing data2)

¹Parameters were dichotomized according to the optimum cut-off from ROC analysis using maximum Youden index;

²Serum IFABP levels were available from 36 patients;

³Dichotomized parameters from univariate analysis were included in a forward-stepwise Cox regression model (P for inclusion < 0.05).