SEPSIS, defined as a disordered host response to severe infection, can lead to multiple organ dysfunction, including liver injury. Sepsis-associated liver dysfunction (SALD) is one of the most common and severe complications, significantly affecting patient outcomes. The liver and gut are closely interconnected through the gut–liver axis, with bidirectional interactions playing a key role in sepsis-related organ damage. In sepsis, inflammation and hypoperfusion disrupt the gut barrier, causing gut bacteria and toxins to translocate to the liver, exacerbating liver injury.
Faecal calprotectin (FC) is a non-invasive biomarker associated with gut inflammation, and its concentration has been shown to correlate with neutrophil migration and the extent of gut injury. Recent studies have suggested that FC could be used as an early diagnostic tool for acute gastrointestinal injury (AGI), which is often present in sepsis patients. However, the relationship between FC and SALD was unclear. To address this gap, a prospective study was conducted to explore the potential association between FC levels and SALD in adults with sepsis.
This study monitored FC concentrations from Days 1–3 following patient enrolment and found that dynamic changes in FC were significantly associated with the development of SALD. Notably, FC levels measured on day 3 were much higher in patients who developed SALD, suggesting that monitoring FC over time could be more effective than relying on a single measurement. The study also found that FC changes were correlated with other clinical indicators, including APACHE II and SOFA scores, as well as inflammatory markers like CRP and IL-6.
Although the study did not find a significant difference in FC levels on Day 1, the rise in FC levels between Days 1 and 3 highlighted ongoing gut inflammation in patients who developed SALD. These findings suggest that persistent gut inflammation may contribute to the onset of liver dysfunction in sepsis. However, limitations such as the small sample size and lack of continuous monitoring suggest that further large-scale, multicentre studies are needed to validate these results and explore the relationship between gut inflammation and liver injury in sepsis.
Reference
Zhang B et al. Association and dynamic change of fecal calprotectin with sepsis associated liver dysfunction in adults with sepsis. Sci Rep. 2025;15(1):16192.
