Acute gut injury: prevalence and impact on outcome in critically ill children

Abstract

Objectives: Primary: To estimate prevalence of acute gut injury (AGI) in critically ill children during first week. Secondary: To estimate impact of AGI on mortality in critically ill children. Material and Methods: Current study is a part of larger prospective cohort study which includes all children aged between 1 month to 18 years admitted to pediatric intensive care unit. Current study analyzed children admitted during December 2017 to April 2018. Children with chronic gastrointestinal symptoms were excluded. European Society of Intensive Care Medicine classification was used to classify for AGI into four categories. Clinical details and outcome parameters were recorded. Results: Thirty-one children were included in the analysis. Median (IQR) age of the children was 32.5 (7.5-96) months; 32% of patients were male. Thirteen (42%) children died. Prevalence of AGI, gut dysfunction (AGI≥2), and gut failure (AGI≥3) was 64.5%, 41.9% and 22.6% respectively. Mortality was significantly increased in patients with AGI, gut dysfunction and gut failure (18% vs 82%, p = 0.047; 22.5% vs 77.8%, p= 0.009 and 29.1% vs 70.9%, p=0.008 respectively). Area under curve of receiver operating curve (AUC-ROC) for prediction of mortality of worst AGI and worst PELOD-2 score in first week were not significantly different (76.4 % and 81.3% respectively, p=0.67). Conclusion: Acute gut injury and gut dysfunction are significant among critically ill children and are associated with increased mortality. With new objective AGI classification, gut dysfunction should be included as measure of organ dysfunction among pediatric organ dysfunction scores.