Acute gastrointestinal injury in the intensive care unit: a retrospective study

Abstract

BackgroundAcute gastrointestinal injury (AGI) is a common problem in the intensive care unit (ICU). This study is a review of the gastrointestinal function of patients in critical care, with the aim to assess the feasibility and effectiveness of grading criteria developed by the European Society of Intensive Care Medicine (ESICM) Working Group on Abdominal Problems (WGAP).MethodsData of patients who were admitted to the ICU of Shenzhen People’s Hospital, Shenzhen, People’s Republic of China, from January 2010 to December 2011 were reviewed. A total of 874 patients were included into the current study. Their sex, age, ICU admissive causes, complication of diabetes, AGI grade, primary or secondary AGI, mechanical ventilation (MV), and length of ICU stay (days) were recorded as risk factors of death. These risk factors were studied by unconditioned logistic regression analysis.ResultsAll the risk factors affected mortality rate. Unconditional logistic regression analysis revealed that the mortality rate of secondary AGI was 71 times higher than primary AGI (odds ratio [OR] 4.335, 95% CI [1.652, 11.375]). When the age increased by one year, the mortality probability would increase fourfold. Mortality in patients with MV was 63-fold higher than for patients with non-MV. Mortality rate increased 0.978 times with each additional day of ICU stay.ConclusionSecondary AGI caused by severe systemic conditions can result in worsened clinical outcomes. The 2012 ESICM WGAP AGI recommendations were to some extent feasible and effective in guiding clinical practices, but the grading system lacked the support of objective laboratory outcomes.

Prevalence and outcome of acute gastrointestinal injury in critically ill patients

“…[ 20 ] AGI may also result from or augment systemic inflammatory reaction syndrome and multiple organ dysfunction syndrome (MODS), in which the release of inflammatory mediators following trauma, surgery, infection, and hemorrhage causes intestinal flora translocation and injury to the intestinal mucus membrane, and results in loss of barrier function, an impaired immune-protective system, and secretion dysfunction. [ 21 , 22 ] Some evidence suggests that the development of MODS is associated with a derangement in intestinal permeability, which is detectable before the onset of MODS, [ 23 ] and that GI dysfunction serves as the main driver of MODS in injured or critically ill patients. [ 12 ] Interestingly, incremental organ failure in MODS results in a 20% increase in mortality.…”

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

“…These findings are in congruence with available evidence in critically ill adults where the presence of AGI was associated with increased mortality. 2 Also in studies where only patients with AGI were included, mortality was higher in AGI grades 2, 3 and 4 compared to AGI grade 1. 8,16 In a paediatric study of transpyloric feeding, children with GI complications had higher mortality (18% vs. 8.4%, P = 0.016) than those without GI complications.…”

Trefoil factor-2, an early predictor for acute gastrointestinal injury in patients with acute pancreatitis

“…In 2012, the Working Group on Abdominal Problems of the European Society of Intensive Care Medicine proposed the guidelines for the grading system of AGI. [ 2 ] Until now, clinical studies [ 15 , 16 ] reported that AGI grading system is feasible and effective in identify severity of GI damage in critically ill patients, but it still lacks the support of quantitative indicators. Our results show that TFF-2 levels have moderately positive correlation with AGI grades after admission from 1st day to 4th day; probably the reason for no strong correlation is that the blood samples were few, but to some degree it still shows that the TFF-2 levels were associated with AGI.…”