Acute gastrointestinal injury in critically ill children: Impact on clinical outcome

Abstract

Aim: To estimate acute gastrointestinal injury (AGI) in critically ill children and association of its severity with mortality. Methods: In a prospective cohort study, critically ill children (1 month-18 years) were enrolled. Gastrointestinal symptoms over the first week of admission were classified into AGI grades 1 through 4, using a paediatric adaptation of European Society of Intensive Care Medicine AGI definitions. Performance of AGI grades in predicting 28-day mortality was evaluated. Results: Of 151 children enrolled, 71 (47%, 95% confidence interval (CI): 38.9-55.3%) developed AGI, with AGI grades 1, 2, 3 and 4 in 22.5%, 15.9%, 6.6% and 2%, respectively. The 28-day mortality progressively increased with AGI grade 0 (15%), 1 (35%), 2 (50%), 3 (70%), through 4 (100%), P < 0.001. Association of AGI grades with 28-day mortality was significant even after adjustment for disease severity, age and nutritional status (odds ratio (OR) = 2.152, 95% CI: 1.455, 3.184). Among AGI grades, and paediatric logistic organ dysfunction-2 score components, cardiovascular (OR = 1.525, 95% CI: 1.142, 2.037) and haematological (OR = 1.719, 95% CI: 1.067, 2.772) components of paediatric logistic organ dysfunction-2 score and AGI grades (OR = 1.565, 95% CI: 1.001, 2.449) showed significant association with 28-day mortality. Conclusions: Nearly half of the critically ill children developed AGI. AGI grades were independently associated with increased mortality, and mortality progressively increased with AGI grade.

Biomarkers and Functional Assays of Epithelial Barrier Disruption and Gastrointestinal Dysmotility in Critical Illness—A Narrative Review

“…They also showed that patients with acute gastrointestinal injury had a higher risk for mortality than those without injury based on the score and that mortality risk was greater as the AGI score increased [ 53 ]. This score was recently applied to a pediatric cohort of critically ill patients and found that the majority of patients had no acute gastrointestinal injury but that in those patients who did, the risk for mortality also increased as the AGI score increased [ 54 ]. The AGI score is limited by its subjectivity, whereby each score is not anchored in objective signs and symptoms but rather, a subjective interpretation of the degree of effect gastrointestinal dysfunction is having on a patient.…”