Prognostic impact of fecal pH in critically ill patients.

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Prognostic impact of fecal pH in critically ill patients.

Crit Care. 2012 Jul 10;16(4):R119

Authors: Osuka A, Shimizu K, Ogura H, Tasaki O, Hamasaki T, Asahara T, Nomoto K, Morotomi M, Kuwagata Y, Shimazu T


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. To determine whether fecal pH can be used as an assessment tool for the clinical course of critically ill patients. METHODS: Four hundred and 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 non-survived group, or non-bacteremia group and bacteremia group. Logistic regression was used to estimate relationships 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: 1.25-4.82) or incidence of bacteremia (3.25, 1.67-6.30). 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 to neutral feces. There were no differences among the group in bacterial counts. CONCLUSIONS: The data presented here demonstrate that the fecal pH range which extended beyond the normal range was associated with the clinical course and prognosis of critically ill patients.

PMID: 22776285 [PubMed - as supplied by publisher]

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