Abstract
BACKGROUND: Sepsis triggered by intra-abdominal infections (IAI) carries significant morbidity and mortality. The gut and kidneys are critically vulnerable in sepsis, with crosstalk potentially driving "intestinal-renal syndrome"-worsening gut dysfunction leading to acute kidney injury (AKI) and vice versa. Doppler ultrasound offers non-invasive hemodynamic assessment: the superior mesenteric artery resistance index (SMARI) reflects splanchnic perfusion, whereas the renal artery resistance index (RRI) indicates renal vascular resistance. However, the combined role of serial SMARI and RRI measurements in tracking intestinal-renal syndrome progression and predicting outcomes in IAI-induced sepsis remains inadequately explored. This study aimed to visually judge the process of enterorenal syndrome in patients with sepsis caused by abdominal infection, and to provide objective evidence for doctors to make treatment decisions. METHODS: This was a retrospective cohort study. A total of 74 patients were included who had been newly admitted into the intensive care unit (ICU) of Zhangzhou Affiliated Hospital of Fujian Medical University. After admission, they were managed with fluid resuscitation in conformity with the early goal-directed therapy (EGDT). Their clinical parameters were collected, including SMARI, RRI, the ultrasonographic transverse area of gastric antrum (CSA, cm(2)), colonic diameter (Diam, cm), and serum creatinine (SCR, mg/dL). Each patient was measured upon admission into the ICU, and 24 and 72 hours afterwards. The cases were divided into a survival group and a death group according to their status on the 28th day. The above parameters of the two groups were statistically analyzed. RESULTS: (I) The survival group had 51 patients and the death group 23 patients. (II) At 24 hours after hospitalization, the survival group showed significant improvement in RRI (P<0.001), CSA (P<0.001) and Diam (P<0.001), improvement in SMARI (P<0.001), and no significant improvement in SCR (P=0.23), compared with the death group. (III) At 72 hours after hospitalization, the survival group showed significant improvement in RRI, CSA, and Diam, and also in SMARI and SCR, compared with the death group (P<0.001 for all). CONCLUSIONS: SMARI, Diam, RRI, and SCR can be monitored to reflect the blood perfusion and functional recovery of the gastrointestinal tract and the kidneys, and thus are objective indicators for the progression of the intestinal-renal syndrome.