BackgroundIn 2012, the European Society of Intensive Care Medicine proposed a definition for acute gastrointestinal injury (AGI) based on current medical evidence and expert opinion. The aim of the present study was to evaluate the feasibility of using the current AGI grading system and to investigate the association between AGI severity grades with clinical outcome in critically ill patients.MethodsAdult patients at 14 general intensive care units (ICUs) with an expected ICU stay ≥24 h were prospectively studied. The AGI grade was assessed daily on the basis of gastrointestinal (GI) symptoms, intra-abdominal pressures, and feeding intolerance (FI) in the first week of admission to the ICU.ResultsAmong the 550 patients enrolled, 456 patients (82.9%) received mechanical ventilation, and 470 patients were identified for AGI. The distribution of the global AGI grade was 24.5% with grade I, 49.4% with grade II, 20.6% with grade III, and 5.5% with grade IV. AGI grading was positively correlated with 28- and 60-day mortality (P < 0.0001). Univariate Cox regression analysis showed that age, sepsis, diabetes mellitus, coronary artery disease, the use of vasoactive drugs, serum creatinine and lactate levels, mechanical ventilation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the global AGI grade were significantly (P ≤ 0.02) associated with 60-day mortality. In a multivariate analysis including these variables, diabetes mellitus (HR 1.43, 95% CI 1.03–1.87; P = 0.05), the use of vasoactive drugs (HR 1.56, 95% CI 1.12–2.11; P = 0.01), serum lactate (HR 1.15, 95% CI 1.06–1.24; P = 0.03), global AGI grade (HR 1.65, 95% CI 1.28–2.12; P = 0.008), and APACHE II score (HR 1.04, 95% CI 1.02–1.06; P < 0.001) were independently associated with 60-day mortality. In a subgroup analysis of 402 patients with 7-day survival, in addition to clinical predictors and the AGI grade on the first day of ICU stay, FI within the first week of ICU stay had an independent and incremental prognostic value for 60-day mortality (χ2 = 41.9 vs. 52.2, P = 0.007).ConclusionsThe AGI grading scheme is useful for identifying the severity of GI dysfunction and could be used as a predictor of impaired outcomes. In addition, these results support the hypothesis that persistent FI within the first week of ICU stay is an independent determinant for mortality.Trial registrationChinese Clinical Trial Registry identifier: ChiCTR-OCS-13003824. Registered on 29 September 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1780-4) contains supplementary material, which is available to authorized users.

BackgroundThere is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery.MethodsThis cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained.ResultsA total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2–19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2–3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353–0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008–0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient – 0.002, 95% CI – 0.008 to − 0.001; p = 0.024) and male gender (coefficient – 0.144, 95% CI – 0.203 to − 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2–3 was associated with lower EN proportion (coefficient – 0.206, 95% CI – 0.273 to − 0.139; p < 0.001).ConclusionsThe study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.

BackgroundThe 2012 European Society of Intensive Care Medicine (ESICM) guidelines provided a clear definition of feeding intolerance (FI). The study aimed to investigate the association between FI based on the current ESICM definition and clinical outcome and to further explore the effect of the duration of FI on mortality.MethodsAdult patients from 14 general intensive care units (ICUs) with an expected ICU stay ≥24 hours were prospectively studied. Based on FI duration in the first week of admission to the ICU, FI was categorized as 7‐day persistent feeding tolerance (FT), delayed FT, delayed FI, and 7‐day persistent FI. The primary outcomes were 28‐day and 60‐day all‐cause mortality.ResultsOf 499 patients, the prevalence of 3‐day and 7‐day persistent FI was 39.2% (n = 196) and 25.4% (n = 106), respectively. The patients with 3‐day FT had lower risk of 28‐day and 60‐day mortality rates and higher prevalence in ventilator weaning and vasoactive medication on the seventh day of ICU admission than those with 3‐day FI. Three‐day FI remained an independent predictor for 60‐day mortality. In a subgroup analysis including 418 patients with 7‐day survival, compared with those with 7‐day persistent FT, the odds ratios of 60‐day mortality were 1.67, 1.97, and 2.62 in the patients with delayed FT, delayed FI, and 7‐day persistent FI, respectively.ConclusionFI was associated with increased mortality and longer duration of mechanical ventilation and vasoactive support. Prolonged or relapsing FI represented an incremental risk of adverse outcomes in critically ill patients.

Sensitive determination of C-reactive protein (CRP) is of great significance because it is an early indicator of inflammation in cardiovascular disease and acute myocardial infarction. A disposable electrode with an integrated three-electrode system (working, reference, and counter electrodes) has great potential in the detection of biomarkers. In this work, an electrochemical immunosensing platform was fabricated on disposable and integrated screen-printed carbon electrode (SPCE) by introducing nanochannel arrays and gated electrochemical signals, which can achieve the sensitive detection of CRP in serum. To introduce active reactive groups for the fabrication of immuno-recognitive interface, vertically-ordered mesoporous silica-nanochannel film (VMSF) with rich amino groups (NH2-VMSF) was rapidly grown by electrochemical assisted self-assembly (EASA). The electrochemically reduced graphene oxide (ErGO) synthesized in situ during the growth of NH2-VMSF was used as a conductive adhesive glue to achieve stable bonding of the nanochannel array (NH2-VMSF/ErGO/SPCE). After the amino group on the outer surface of NH2-VMSF reacted with bifunctional glutaraldehyde (GA/NH2-VMSF/ErGO/SPCE), the converted aldehyde surface was applied for covalent immobilization of the recognitive antibody (Ab) followed with the blocking of the non-specific sites. The fabricated immunosensor, Ab/GA/NH2-VMSF/ErGO/SPCE, enables sensitive detection of CRP in the range from 10 pg/mL to 100 ng/mL with low limit of detection (LOD, 8 pg/mL, S/N = 3). The immunosensor possessed high selectivity and can realize reliable determination of CRP in human serum.