Minimized and conventional cardiopulmonary bypass damage intestinal mucosal integrity

Figures & data

Table I. Mucosal epithelial damage score and combined score for the assessment of immunohistochemical staining in claudin proteins.

Mucosal epithelial damage score to quantify the degree of changes in epithelial integrity
	Score
Criterion	0	1	2	3	4
Degeneration	0–5%	6–10%	11–50%	51–75%	76–100%
Defect	0%	0–5%	6–25%	26–50%	50–75%

Combined score for the assessment of immunohistochemical staining in claudin proteins
Intensity	Quantity	Combined score (=Intensity +Quantity)
1 = weak	0 = no positivity	0 = absent
2 = moderate	1 = <25%	1–2 = weak
3 = strong	2 = 25–50%	3–4 = moderate
4 = very strong	3 = 50–75%	5–6 = strong
	4 = >75%	7–8 = very strong

Table II. Descriptive data of the study groups and the two sham animals.

	Baseline	60 min	120 min	180 min	240 min	p
MAP, mmHg
MCPB	82 (76;89)	58 (56;65)	60 (56;65)	67 (60;74)	61 (56;69)	pt < 0.05
CCPB	81 (73;90)	63 (58;69)	67 (59;75)	77 (60;78)	60 (57;65)	pg = 0.84
SHAM	89;84	91;84	94;90	86;86	78;69	pt*g = 0.21
CVP, mmHg
MCPB	7 (6;8)	4 (3;5)	3 (2;4)	3 (2;4)	4 (3;6)	pt = 0.001
CCPB	6 (4;6)	4 (3;4)	3 (2;4)	2 (1;4)	2 (1;4)	pg = 0.29
SHAM	5;4	5;3	5;4	5;3	5;3	Pt*g = 0.63
Temp (°C)
MCPB	37.3 (35.9;37.8)	34.2 (34;34.2)	34.0 (34;34.1)	34.0 (34;34)	36.0 (35.8;36.4)	pt < 0.05
CCPB	37.6 (37.1;37.7)	34.0 (33.9;34)	33.9 (33.9;34)	34.0 (34;34)	36.0 (35.9;37)	pg = 0.25
SHAM	37.7;37.6	38.3;38.0	38.5;38.3	38.5;38.3	37.7;37.6	pt*g = 0.35
Hemoglobin, g/l
MCPB	68 (68;75)	71 (68;82)	68 (68;78)	68 (58;68)	65 (58;75)	pt < 0.05
CCPB	65 (61;78)	61 (48;68)	68 (51;68)	54 (48;68)	51 (41;65)	pg = 0.08
SHAM	65;67	68;78	68;68	68;75	71;74	pt*g = 0.46
SvO2,%
MCPB	81 (81;83)	80 (80;85)	70 (67;79)	75 (66;81)	65 (58;70)	pt < 0.05
CCPB	79 (75;82)	79 (74;82)	70 (61;76)	70 (61;77)	61 (54;67)	pg = 0.43
SHAM	81;82	75;77	79;79	83;83	79;80	pt*g = 0.95
SpO2,%
MCPB	87 (83;89)	85 (83;86)	80 (77;83)	80 (78;83)	80 (76;85)	pt < 0.05
CCPB	85 (79;86)	86 (77;88)	80 (80;86)	80 (73;80)	73 (67;79)	pg = 0.27
SHAM	88;88	85;88	87;88	84;87	88;88	pt*g = 0.37
CI, ml/kg/min
MCPB	132 (121;171)	74 (66;90)	66 (64;70)	67 (63;74)	70 (63;77)	pt < 0.05
CCPB	133 (115;144)	91 (83;100)	81 (73;86)	91 (83;100)	97 (73;100)	pg < 0.05
SHAM	152;175	129;157	148;153	136;139	128;136	pt*g = 0.08
Qspli, ml/kg/min
MCPB	37 (31;43)	29 (25;33)	30 (26;32)	25 (22;33)	26 (23;29)	pt < 0.05
CCPB	35 (32;38)	33 (24;34)	32 (27;35)	27 (19;32)	29 (15;35)	pg = 0.98
SHAM	36;45	29;40	29;36	36;40	36;39	pt*g = 0.91
Qspli/CI%
MCPB	24 (23;26)	37 (34;42)	43 (38;58)	37 (35;45)	34 (31;38)	pt < 0.05
CCPB	25 (18;33)	33 (31;35)	32 (29;39)	32 (26;37)	29 (23;34)	pg = 0.07
SHAM	23;26	23;25	20;23	26;28	22;25	pt*g < 0.05
Systemic DO2 i, ml/kg/min
MCPB	13.8 (12.9;16.1)	7.0 (6.7;8.0)	6.7 (6.2;7.6)	6.1 (5.9;6.5)	6.4 (6.3;6.9)	pt < 0.05
CCPB	13.0 (10.0;15.7)	7.8 (6.6;7.8)	6.9 (5.8;8.2)	7.0 (5.7;7.6)	5.9 (5.7;7.2)	pg = 0.98
SHAM	14.4;16;1	15.8;17;6	16.5;17.3	14.1;14.4	13.9;14.0	Pt*g = 0.22
Systemic VO2 i, ml/kg/min
MCPB	2.6 (2.5;3.0)	1.4 (1.2;2.1)	1.9 (1.4;2.3)	1.4 (1.2;2.1)	2.1 (1.9;2.5)	pt < 0.05
CCPB	2.5 (2.1;3.3)	1.7 (1.5;2.0)	2.1 (1.8;2.5)	2.1 (1.4;2.6)	2.4 (1.9;2.7)	pg = 0.40
SHAM	2.3;2.8	3.9;3;9	3.5;3.6	2.4;2.5	2.6;2.8	pt*g = 0.58
Gut DO2 i, ml/kg/min
MCPB	3.4 (2.9;4.4)	2.8 (2.6;3.3)	2.8 (2.5;3.4)	2.3 (1.7;2.8)	2.3 (1.6;2.4)	pt < 0.05
CCPB	3.4 (2.7;3.8)	2.4 (1.9;3.2)	2.5 (1.7;3.3)	1.9 (1.6;2.2)	1.6 (1.5;2.0)	pg = 0.21
SHAM	3.4;4.1	3.6;4.4	3.5;4.0	3.9;4.1	3.8;3.9	pt*g = 0.94
Gut VO2 i, ml/kg/min
MCPB	0.46 (0.37;0.54)	0.40 (0.33;0.49)	0.54 (0.46;0.70)	0.42 (0.29;0.57)	0.35 (027;0.54)	pt = 0.14
CCPB	0.53 (0.51;0.64)	0.41 (0.25;0.74)	0.54 (0.50;0.58)	0.44 (0.40;0.47)	0.56 (0.38;0.67)	pg = 0.21
SHAM	0.50;0.54	0.41;0.41	0.46;0.47	0.43;0.56	0.45;0.46	pt*g = 0.53
Systemic DO2 :VO2
MCPB	0.19 (0.17;0.22)	0.20 (0.15;0.26)	0.30 (0.21;0.33)	0.25 (0.19;0.34)	0.35 (0.30;0.42)	pt < 0.05
CCPB	0.21 (0.18;0.25)	0.21 (0.18;0.26)	0.30 (0.24;0.38)	0.30 (0.23;0.39)	0.33 (0.30;0.46)	pg = 0.55
SHAM	0.16;0.18	0.19;0.22	0.21;0.21	0.17;0.17	0.19;0.20	Pt*g = 0.23
Gut DO2:VO2
MCPB	0.13 (0.12;0.17)	0.15 (0.12;0.18)	0.20 (0.16;0.23)	0.20 (0.17;0.23)	0.20 (0.15;0.24)	pt < 0.05
CCPB	0.15 (0.13;0.24)	0.15 (0.11;0.31)	0.19 (0.14;0.26)	0.20 (0.19;0.27)	0.27 (0.21;0.33)	pg = 0.22
SHAM	0.12;0.13	0.08;0.10	0.11;0.12	0.11;0.14	0.11;0.11	Pt*g = 0.64
Lactate
MCPB	1.54 (1.29;1.78)		1.20 (0.87;1.52)		1.11 (1.05;1.32)	pt = 0.45
CCPB	2.11 (1.42;2.59)		1.56 (1.17;3.07)		1.74 (1.28;2.27)	pg < 0.05
SHAM	1.63;1.63		0.51;0.99		0.30;0.53	Pt*g = 0.65
Portal lactate
MCPB	1.54 (1.31;1.99)		1.33 (1.03;1.44)		1.27 (1.11;1.35)	pt = 0.27
CCPB	2.35 (1.65;2.59)		1.58 (1.22;2.47)		1.65 (1.28;2.30)	pg = 0.10
SHAM	1.72;1.73		0.61;1.07		0.72;0.82	Pt*g = 0.85

MAP, mean arterial pressure; CVP, central venous pressure; Temp, rectal temperature; SvO₂, mixed venous oxygen saturation; S_pO₂, portal venous oxygen saturation; CI, cardiac output indexed to bodyweight; Qspli, a. mesenterica superior blood flow + a. truncus coeliacus blood flow; Systemic DO₂, systemic oxygen delivery index; Systemic VO₂i, systemic oxygen consumption index; Gut DO₂i, gut oxygen delivery index; Gut VO₂i, gut oxygen consumption index (median and interquartile range). Reported p-values are as follows: p between groups (p_g) indicates a level of difference between the groups, p over time (p_t) indicates changes of measurements over time, p for time by group (p_t*g), indicates behavior between the groups with time.

Figure 1. Mucosal damage scores (median, 25th, 75th percentiles) of ileal (ileal) and colon (right) biopsies at baseline and at 240 minutes of cardiopulmonary bypass (CPB) in the study groups and in the two sham animals.

Figure 2. Median (25th, 75th percentiles) combined scores of cells staining positively for claudins in ileum and colon in the study groups and in the two sham animals. CL1, claudin-1; CL2, claudin-2; CL3, claudin-3; CL4, claudin-4; CL5, claudin-5; CL7, claudin-7.

Figure 3. Micrographs of hematoxylin/eosin (HE-)-stained sections of colon biopsies of animals in the MCPB (first row), CCPB (second row) groups and in a sham animal (third row) at baseline and at 240 minutes on CPB. Bar = 250 μm.

Figure 4. Micrographs of sections of colon biopsies showing immunohistochemical staining for claudin-4 (CL4) in the minimized cardiopulmonary bypass (MCPB) (first row), conventional cardiopulmonary bypass (CCPB) (second row) groups and in a sham animal (third row) at baseline and at 240 minutes on cardiopulmonary bypass (CPB). Bar = 250 μm.