Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients

Drakos, Panagiotis; Volteas, Panagiotis; Cleri, Nathaniel A; Alkadaa, Leor N; Asencio, Anthony A; Oganov, Anthony; Pryor, Aurora D.; Talamini, Mark A.; Rubano, Jerry A.; Bannazadeh, Mohsen; Mikell, Charles B.; Spaniolas, Konstantinos; Mofakham, Sima

doi:10.1007/s11605-021-05015-z

Cited by 9 publications

(12 citation statements)

References 32 publications

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“…Drakos et al performed Kaplan‐Meier survival analysis, various other statistical tests and determined that the development of acute gastrointestinal injury (AGI) and intolerance to feeds during the initial days can serve as prognostic tools for predicting outcomes in critically ill COVID‐19 ICU patients. Higher grades of AGI also correlated with the increased levels of d ‐dimer and C‐reactive protein as shown in the Figure 3 38 …”

Section: Discussionmentioning

confidence: 73%

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Bowel ischemia in COVID‐19: A systematic review

Patel

Parikh

Verma

et al. 2021

Int J Clinical Practice

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Background Gastrointestinal complications of COVID‐19 have been reported over the last year. One such manifestation is bowel ischaemia. This study thus aims to provide a more holistic review of our current understanding of COVID‐19‐induced bowel ischaemia. Method and Results A meticulous search was performed using different keywords in PubMed and Google Scholar. Fifty‐two articles were included in our study after applying inclusion and exclusion criteria and performing the qualitative assessment of the studies. A total of 25 702 patients were included in our study after the completion of the qualitative assessment. Discussion The common symptoms of GIT in COVID‐19 patients are as diarrhoea, vomiting, nausea and abdominal pain. The mechanism of bowel ischaemia is associated with the formation of emboli which is related to COVID‐19’s high affinity for angiotensin‐converting enzyme‐2 on enterocytes, affecting the superior mesenteric vessels. Clinically, patients present with abdominal pain and vomiting. CT angiography of the abdomen and pelvis showed acute intestinal ischaemia (mesenteric). Management is usually initiated with gastric decompression, fluid resuscitation, and haemodynamic support. Surgical intervention is also sought. Conclusion Intestinal ischaemia presenting in patients with COVID‐19 has to be considered when symptoms of severe abdominal pain are present. More research and guidelines are required to triage patients with COVID‐19 to suspect intestinal ischaemia and to help in diagnosis and management.

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Section: Discussionmentioning

confidence: 73%

“…Higher grades of AGI also correlated with the increased levels of d ‐dimer and C‐reactive protein as shown in the Figure 3 . 38 …”

Section: Discussionmentioning

confidence: 99%

Bowel ischemia in COVID‐19: A systematic review

Patel

Parikh

Verma

et al. 2021

Int J Clinical Practice

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“…More than 50% of the patients presented with grade III and IV AGI, and worse outcomes, such as longer days of mechanical ventilation provision, longer duration of hospital stay, and increased mortality were reported in 58% of the patients. [ 5 ] One of the associations proposed in this study was the relationship between elevated D-dimer levels and AGI, suggesting the presence of a hypercoagulable state that leads to microvascular thrombosis despite the administration of therapeutic anticoagulation. However, since performing autopsies and histopathological analyses for these patients were not possible, this theory could not be confirmed.…”

Section: Discussionmentioning

confidence: 82%

“…However, since performing autopsies and histopathological analyses for these patients were not possible, this theory could not be confirmed. [5] Different authors consider thrombotic phenomena to be the cause of intestinal perforation and ischemia in patients with SARS-CoV-2 infection, [5,[8][9][10] Observational studies have found that thromboembolic events occur in 21% to 69% of these patients, of which 6.4% have arterial (intestinal and peripheral) thrombosis. [11,12] In this study, histological sections of intestinal tissue collected from patients with grade IV AGI revealed ischemic and liquefactive intestinal necrosis with a severe inflammatory response mediated by neutrophils and lymphocytes in the absence of vascular thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Severe gastrointestinal injury associated with SARS-CoV-2 infection: Thrombosis or Inflammation?: A retrospective case series study

et al. 2022

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Objectives: Acute gastrointestinal injury (AGI) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has a low incidence of complications in patients admitted to the intensive care unit (ICU). Pathophysiological knowledge related to AGI is limited, as few studies have been published on this topic. Therefore, this study was carried out to identify the clinical and histopathological features of patients with SARS-CoV-2 infection and grade IV AGI. Methods: This is a retrospective case study of fifteen patients with SARS-CoV-2 infection and grade IV AGI who underwent emergency surgery. Results: This study revealed a mortality rate of 62.5%. The most frequent gastrointestinal symptoms were abdominal distension (100%) and increased gastric residual volume (93.3%). Distended bowel loops on plain abdominal radiography (90%) and intestinal pneumatosis on computed tomography (50%) were the most frequent imaging findings. Surgical exploration revealed intestinal ischemia (66.6%) and necrosis (46.6%), and histopathology showed ischemic and liquefactive necrosis with mixed inflammatory involvement and absence of thrombosis as the cause of AGI. Conclusions: AGI associated with severe SARS-CoV-2 infection has a high mortality rate and poses a diagnostic challenge in the ICU. The complex pathophysiology and histopathological findings indicate an associated inflammatory phenomenon as the main alteration in the absence of thrombosis, as per the intestinal biopsies of the cases studied. Further clinical studies are required to gain a better understanding of this pathology.

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“…The overall incidence of AGI was 95% (45% AGI I/II, 50% AGI III/IV), and FI incidence was 63%. Patients with AGI III/IV were more likely to have prolonged mechanical ventilation (22 days vs 16 days, p-value < 0.002) and higher mortality rate (58% vs 28%, p-value < 0.001) compared to patients with AGI 0/I/II 75 . Our findings are consistent with conclusions from the previous publications.…”

Section: Discussionmentioning

confidence: 93%

An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature

Lavrentieva

Kaimakamis

Voutsas

et al. 2023

Sci Rep

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The novel pandemic caused by SARS-CoV-2 has been associated with increased burden on healthcare system. Recognizing the variables that independently predict death in COVID-19 is of great importance. The study was carried out prospectively in a single ICU in northern Greece. It was based on the collection of data during clinical practice in 375 adult patients who were tested positive for SARS-CoV-2 between April 2020 and February 2022. All patients were intubated due to acute respiratory insufficiency and received Invasive Mechanical Ventilation. The primary outcome was ICU mortality. Secondary outcomes were 28-day mortality and independent predictors of mortality at 28 days and during ICU hospitalization. For continuous variables with normal distribution, t-test was used for means comparison between two groups and one-way ANOVA for multiple comparisons. When the distribution was not normal, comparisons were performed using the Mann–Whitney test. Comparisons between discrete variables were made using the x2 test, whereas the binary logistic regression was employed for the definition of factors affecting survival inside the ICU and after 28 days. Of the total number of patients intubated due to COVID-19 during the study period, 239 (63.7%) were male. Overall, the ICU survival was 49.6%, whereas the 28-day survival reached 46.9%. The survival rates inside the ICU for the four main viral variants were 54.9%, 50.3%, 39.7% and 50% for the Alpha, Beta, Delta and Omicron variants, respectively. Logistic regressions for outcome revealed that the following parameters were independently associated with ICU survival: wave, SOFA @day1, Remdesivir use, AKI, Sepsis, Enteral Insufficiency, Duration of ICU stay and WBC. Similarly, the parameters affecting the 28-days survival were: duration of stay in ICU, SOFA @day1, WBC, Wave, AKI and Enteral Insufficiency. In this observational cohort study of critically ill COVID-19 patients we report an association between mortality and the wave sequence, SOFA score on admission, the use of Remdesivir, presence of AKI, presence of gastrointestinal failure, sepsis and WBC levels. Strengths of this study are the large number of critically ill COVID-19 patients included, and the comparison of the adjusted mortality rates between pandemic waves within a two year-study period.

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Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients

Cited by 9 publications

References 32 publications

Bowel ischemia in COVID‐19: A systematic review

Bowel ischemia in COVID‐19: A systematic review

Severe gastrointestinal injury associated with SARS-CoV-2 infection: Thrombosis or Inflammation?: A retrospective case series study

An observational study on factors associated with ICU mortality in Covid-19 patients and critical review of the literature

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