Clinical study of acute gastrointestinal injury classification in early enteral nutrition in patients under intensive care

Abstract

To study the feasibility of the acute gastrointestinal injury (AGI) classification standard for evaluation of gastrointestinal function in intensive care unit (ICU) patients, and to discuss its value in administration of early enteral nutrition (EN). A perspective study was conducted. 85 patients with AGI admitted to ICU of Tianjin First Center Hospital from January 2013 to June 2013 were enrolled. EN was conducted after ICU admission or within 12-24 hours after high catabolic state. The patients were divided into four groups according to the AGI classification, i.e. grade I, II, III, and IV, and they were treated according to the treatment procedure for AGI. The primary end points were 7-day rate of intake of standard EN, the degree of disease and nutrition, and their correlation with AGI classification. Secondary endpoint was rate of giving EN within 48 hours. Gastrointestinal dysfunction patients accounted for 49.42% (85/172) of the ICU patients, and number of patients in grade I, II, III, IV were 29, 28, 19, 9 respectively. On the first day of ICU stay, there were no statistical differences in age, acute physiology and chronic health evaluation II (APACHEII) score, serum albumin (ALB) and prealbumin (PA) among four groups, and it was demonstrated that the baseline data were comparable. APACHEII score on the seventh day of ICU stay was significantly lower than that on the first day in grade I, II and III patients (grade I: 20.48±2.45 vs. 22.59±2.06, t=-3.120, P=0.031; grade II: 19.34±1.80 vs. 21.65±2.22, t=-4.316, P=0.012; grade III: 20.63±1.34 vs. 23.31±1.70, t=-5.640, P=0.000), and serum PA was significantly increased (grade I: 24.37±6.54 g/L vs. 10.62±7.24 g/L, t=-4.866, P=0.000; grade II: 19.79±12.48 g/L vs. 11.57±8.94 g/L, t=-2.116, P=0.031; grade III: 19.15±8.43 g/L vs. 13.78±6.59 g/L, t=-3.601, P=0.000). On the seventh day of ICU stay, the APACHEII score was higher in grade IV than that in grade I, II and III patients (22.87±3.31 vs. 20.48±2.45, 19.34±1.80, 20.63±1.34, P<0.05 or P<0.01), and PA was obviously lower in grade IV than that in grade I, II and III patients (14.02±8.70 g/L vs. 24.37±6.54 g/L, 19.79±12.48 g/L, 19.15±8.43 g/L, P<0.05 or P<0.01). There was no statistically significant difference among four groups in respect of serum ALB (F=0.454, P=0.722). The rate of giving EN in 24 hours in grade I, II, III, IV patients was 95.4%, 72.1%, 52.0% and 0, respectively (χ2=8.310, P=0.016), and in 48 hours it was 100.0%, 83.0%, 76.0%, and 0 (χ2=5.470, P=0.025). 7-day standard EN intake rate was 100.0%, 88.7%, 84.0% and 34.0% respectively in grade I, II, III, IV patients (χ2=0.720, P=0.017). Correlation analysis showed that there was a negative correlation between AGI classification and rate of giving EN in 1 day (r=-0.62, P=0.04) and 7-day standard EN intake rate (r=-0.76, P=0.02). AGI classification can be used to estimate the gastrointestinal function of patients with critical illness, and it has a significant correlation with early EN support. An early goal achieving intervention based on the AGI classification can improve the nutritional status and the general state of the patients.