Effect of a multispecies probiotic on inflammatory markers in critically ill patients: A randomized, double-blind, placebo-controlled trial

Background: Impairment of intestinal barrier function and increased translocation of bacteria to the systemic blood flow contribute to the emergence of sepsis. Probiotics might be of beneficial effects on critically ill-patients, modulating intestinal barrier function and reducing inflammation. The aim of this trial was to determine the effect of probiotics on inflammatory markers in critically ill-patients in Intensive Care Unit (ICU). Materials and Methods: This trial was conducted on 40 critically ill-patients admitted to the ICU. Patients were randomly assigned to receive placebo or probiotic containing Lactobacillus, Bifidobacterium and Streptococcus thermophilus (VSL#3) for 7 days. Acute Physiology and Chronic Health Evaluation (APACHE II) score Sequential Organ Failure Assessment (SOFA) and systemic concentrations of interleukin-6 (IL-6), procalcitonin (PCT) and protein C were measured before initiation of the study and on days 4 and 7. Results: A significant difference in IL-6 (P = 0.003), PCT (P = 0.014) and protein C (P < 0.001) levels, and also APACHE II and SOFA scores (P < 0.001) was seen over the treatment period between two groups. Moreover, there was a significant decrease in serum IL-6 levels (from 211.85 +/- 112.76 to 71.80 +/- 28.41) (P < 0.001) and PCT levels (from 1.67 +/- 1.27 to 0.47 +/- 0.41) (P < 0.001) and a significant increase in serum protein C levels (from 7.47 +/- 3.61 to 12.87 +/- 3.63) (P < 0.001) in probiotic group during the study. Conclusion: Probiotics could reduce inflammation in critically ill-patients and might be considered as an adjunctive therapy in the treatment of critically ill-patients.