Acute Gastrointestinal Injury Grade Research Articles

Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study

BackgroundIn 2012, the European Society of Intensive Care Medicine proposed a definition for acute gastrointestinal injury (AGI) based on current medical evidence and expert opinion. The aim of the present study was to evaluate the feasibility of using the current AGI grading system and to investigate the association between AGI severity grades with clinical outcome in critically ill patients.MethodsAdult patients at 14 general intensive care units (ICUs) with an expected ICU stay ≥24 h were prospectively studied. The AGI grade was assessed daily on the basis of gastrointestinal (GI) symptoms, intra-abdominal pressures, and feeding intolerance (FI) in the first week of admission to the ICU.ResultsAmong the 550 patients enrolled, 456 patients (82.9%) received mechanical ventilation, and 470 patients were identified for AGI. The distribution of the global AGI grade was 24.5% with grade I, 49.4% with grade II, 20.6% with grade III, and 5.5% with grade IV. AGI grading was positively correlated with 28- and 60-day mortality (P < 0.0001). Univariate Cox regression analysis showed that age, sepsis, diabetes mellitus, coronary artery disease, the use of vasoactive drugs, serum creatinine and lactate levels, mechanical ventilation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and the global AGI grade were significantly (P ≤ 0.02) associated with 60-day mortality. In a multivariate analysis including these variables, diabetes mellitus (HR 1.43, 95% CI 1.03–1.87; P = 0.05), the use of vasoactive drugs (HR 1.56, 95% CI 1.12–2.11; P = 0.01), serum lactate (HR 1.15, 95% CI 1.06–1.24; P = 0.03), global AGI grade (HR 1.65, 95% CI 1.28–2.12; P = 0.008), and APACHE II score (HR 1.04, 95% CI 1.02–1.06; P < 0.001) were independently associated with 60-day mortality. In a subgroup analysis of 402 patients with 7-day survival, in addition to clinical predictors and the AGI grade on the first day of ICU stay, FI within the first week of ICU stay had an independent and incremental prognostic value for 60-day mortality (χ2 = 41.9 vs. 52.2, P = 0.007).ConclusionsThe AGI grading scheme is useful for identifying the severity of GI dysfunction and could be used as a predictor of impaired outcomes. In addition, these results support the hypothesis that persistent FI within the first week of ICU stay is an independent determinant for mortality.Trial registrationChinese Clinical Trial Registry identifier: ChiCTR-OCS-13003824. Registered on 29 September 2013.

Is nasogastric or nasojejunal enteral feeding more appropriate in severe acute pancreatitis?

Early enteral nutrition (EN) can improve the prognosis of acute pancreatitis (AP), but the optimal initiation time is unknown. In this study, the optimal time of early EN was analyzed to disclose the application of early EN in AP.Data of 104 patients with AP were prospectively collected. With secondary infection (infected pancreatic necrosis and extrapancreatic infection) as the primary outcome variable, receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off time of early EN. Propensity score matching was used to adjust for covariates. Secondary outcomes include acute gastrointestinal injury (AGI) grades, serum albumin level, and EN-related complications.The ROC curve analysis showed that the third day after hospital admission was the best cut-off time of early EN (with the area under the curve of 0.744). After PS matching, the proportion of secondary infection in the early EN group was significantly lower than the late EN group (8.6% vs. 36.5%, P < 0.05). Regression analysis showed that early EN was a protective factor against secondary infection (OR 0.161, 95%CI 0.036–0.718, P < 0.05). The AGI grades and serum albumin levels were better improved in the early EN group (AGI F = 4.468, P < 0.05; serum albumin F = 3.794, P < 0.05).The proportion of EN-related abdominal distension in the early EN group was significantly lower (8.8% vs. 38.5%, P < 0.05).Early EN initiated within three days could reduce the risk of secondary infection and improve the nutritional status of patients with acute pancreatitis, with a better tolerance.

Comparison of the clinical characteristics and prognosis of primary versus secondary acute gastrointestinal injury in critically ill patients

BackgroundThis prospective study compared clinical characteristics and prognosis between primary (P) and secondary (S) acute gastrointestinal injury (AGI) (P-AGI)/(S-AGI) in critically ill patients.MethodsThis was a prospective, single-center observational study. Patients were included if they had been hospitalized for at least 72 h before the AGI diagnosis. Patients were classified according to severity of gastrointestinal dysfunction, while P-AGI or S-AGI were defined according to whether the gastrointestinal system was directly or indirectly involved. Clinical characteristics, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and Sepsis-related Organ Failure Assessment (SOFA) scores after inclusion and 28-day mortality were recorded.ResultsAltogether, 282 patients were included: P and S groups enrolled 100 and 182 patients, respectively. The S group patients were older and showed increased morbidities and higher APACHE II and SOFA scores. Compared to the S group, the P group had a higher prevalence in abdominal distention and enteroparalysis and fewer patients at AGI grade I, while more patients at grade III or IV. The S group patients had the higher 28-day mortality. Multiple logistic regression analysis showed AGI grades, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality.ConclusionsComparing to the P-AGI patients, the S group patients were older, with higher APACHE II and SOFA scores. AGI grade, APACHE II score, and S-AGI independently predicted the odds of 28-day mortality in AGI patients.

The association between feeding intolerance and clinical outcome in critically ill patients admitted to ICU: a multi-center prospective, observational study

Objective To investigate the prevalence of feeding intolerance (FI), and to explore the FI within 7 days of ICU admission in association with clinical outcome in critically ill patients. Methods The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24h were recruited from March 2014 to August 2014, and all clinical, laboratory, and survival data were prospectively collected. The AGI (acute gastrointestinal injury) grade was daily assessed based on gastrointestinal (GI) symptoms, feeding details and organ dysfunction within the first week of ICU stay. The intra-abdominal pressures (IAP) was measured using AbViser device. Results Of 550 patients enrolled, 418 were assessed in GI symptoms and feeding details within 7 days of ICU stay. The mean age and SOFA score were (65.1±18.3) years and (8.96±4.10), respectively. Of them, 355 patients (84.9%) were under mechanical ventilation support, and 37 (8.85%) received renal replacement therapy. The mean length of time for enteral feeding was (30.8±26.2) h, and the prevalence of FI on the 3rd and 7th day of ICU stay accounted for 39.2%and 25.4%, respectively. Compared to those with FI within 7 days of ICU stay, the patients without FI had higher rate of successively weaning from mechanical ventilation (21.3% vs. 5.7%, P=0.003) and higher rate of withdrawal of vasoactive medication (45.5% vs. 20.0%, P=0.037), as well as lower mortality rate of 28-day (24.4% vs. 38.7%, P=0.004) and 60-day (29.6% vs. 44.3%, P=0.005). In multivariate Cox regression model with adjustment for age, sex, participant center, serum creatinine and lactate, AGI grade on the first day of ICU stay, and comorbidities, the FI within 7 days of ICU stay (χ2≥7.24, P<0.01) remained to be independent predictors for 60-day mortality. After further adjusted for SOFA score, the FI within 7 days of ICU stay (HR=1.71, 95%CI: 1.18-2.49; P=0.006) and AGI grade on the first day of ICU stay (HR=1.33, 95%CI: 1.07-1.65; P=0.009) could provide independent prognostic values of 60-day mortality. Conclusions There is high rate of FI occurred within 7 days of ICU stay, and is significantly associated with worse outcome. In addition, this study also provides evidence to further support that measurement of gastrointestinal dysfunction could increase value of SOFA score in outcome prediction for the risk of 60-day mortality. Key words: Critically ill patient; Feeding intolerance; Acute gastrointestinal injury; SOFA score; Prognosis

Association between acute gastrointestinal injury and biomarkers of intestinal barrier function in critically ill patients

BackgroundTo assess the associations of biomarkers of intestinal barrier function and other clinical variables with acute gastrointestinal injury (AGI) grade, and of these clinical variables with mortality in critically ill patients.MethodsThis was a single-center, observational, prospective study. Patients were included if they were diagnosed with AGI and underwent tests for the measurement of plasma levels of intestinal fatty acid–binding protein (i-FABP), d-lactate (d-la), and lipopolysaccharide. General characteristics, AGI grades, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, Sepsis-related Organ Failure Assessment (SOFA) scores, intra-abdominal pressure (IAP), and 28-day mortality were recorded and compared among patients with different AGI grades.ResultsAmong the 90 included patients, the APACHE II score, IAP, and LPS and D-la levels significantly differed between the four AGI grades. Multinomial logistic regression analysis with grade I as the reference for grades II, III, and IV revealed that high APACHE II scores increased the odds of AGI grade III (odds ratio [OR], 1.754; 95% confidence interval [CI], 1.225–2.511) and grade IV (OR, 1.493; 95% CI, 1.079–2.066). Similarly, IAP increased the odds of AGI grade III (OR, 1.622; 95% CI, 1.111–2.369) and grade IV (OR, 1.518; 95% CI, 1.066–2.162). Elevated D-la increased the odds of AGI grades II (OR, 1.059; 95% CI, 1.005–1.117), III (OR, 1.155; 95% CI, 1.052–2.268), and IV (OR, 1.088; 95% CI, 1.013–1.168). In contrast, i-FABP and LPS did not increase the odds of any AGI grade. SOFA scores could independently predict the odds of death in AGI patients (OR, 1.223; 95% CI, 1.007–1.485).ConclusionAGI patients exhibit loss of gastrointestinal barrier function, and d-la could serve as a better marker of AGI grade than i-FABP or lipopolysaccharide.

Clinical application of Acutegastrointestinal injury grading system assocaited with clinical severity outcome in critically ill patients: a multi-center prospective, observational study

Objective: To investigate the feasibility of utilizing the current acute gastrointestinal injury(AGI) grading system, and explore the association of severity of AGI grade with clinical outcome in critically ill patients. Methods: The adult patients from 14 general ICUs in Zhejiang Province with an expected admission to ICU for at least 24 h were recruited, and all clinical, laboratory, and survival data were prospectively collected. The AGI grade was daily assessed based on GIsymptoms, feeding details and organ dysfunctionon the first week of admission to ICU.The intra-abdominal pressures(IAP) was measured using AbViser device. Results: Of 550 patients enrolled, mean values for age and APACHE Ⅱ score were (64.9±17.2) years and (19.5±7.4), respectively. 456 patients(82.9%) took mechanical ventilation, and 470 patients were identified for AGI. The distribution of AGI grade on the frist day of ICU admission were 50.6%(Ⅰ grade, n=238), 34.2%(Ⅱ grade, n=161), 12.4%(Ⅲ grade, n=58) and 2.8%(Ⅳ, n=13), respectively, while the distribution of the global AGI grade based on the 7-day AGI assessment of ICU admission were 24.5%(Ⅰ grade, n=115), 49.4%(Ⅱ grade, n=232), 20.6%(Ⅲ grade, n=97) and 5.5%(Ⅳ, n=26), respectively. 28- and 60-day mortality rate was 29.3%(n=161) and 32.5%(n=179), respectively. The patients with AGI had a higher 28-(31.1% vs 18.8%, P=0.025) and 60-day survival rate(34.7% vs 20.0%, P=0.01) than those with non-AGI, and also there were positive correlations between AGI grade and 28- and 60-day mortality(P<0.001). Univariate Cox regression analysis showed that age, the source of medicial admission, diabetes mellitus, coronary heart disease, the use of vasoactive drugs, serum creatinine and lactate, mechanical ventilation, APACHE Ⅱ score, the AGI grade in the first day of ICU admission and feeding intolerance within the first week of ICU stay were significantly(P≤0.02) associated with mortality. In multivariate analysis including all these variables, the source of medical admission(χ(2)=4.34, P=0.04), diabete mellitus(χ(2)=3.96, P=0.05), the use of vasoactive drugs(χ(2)=6.55, P=0.01), serum lactate(χ(2)=4.73, P=0.03), the global AGI grade in the 7-day of ICU admission(χ(2)=7.10, P=0.008), and APACHE Ⅱ score(χ(2)=12.1, P<0.001) remained independent predictors for 60-day mortality.In the further subgroup analysis including 402 patients with 7-day survival, the feeding intolerance within the first week of ICU stay could provide independent and incremental prognostic value of 60-day mortality wtih increased χ(2)value of Cox regression model(χ(2)=52.2 vs 41.9, P=0.007) . Conclusion: The AGI grading system is useful for identifying the severity of gastrointestinal dysfunction, and could be used as a strong predictor of impaired outcome. The results provide evidence to support that feeding intolerance within 7 days of admission to ICU was an independent determinant of mortality.

Predictive value of SOFA score combined AGI grading system in elderly patients with sepsis: a retrospective analysis with 91 patients

To explore the predictive value of sequential organ failure assessment (SOFA) score combined the acute gastrointestinal injury (AGI) grading system in critical elderly patients with sepsis. A retrospective analysis was conducted. Elderly patients with sepsis aged > 60 years admitted to medical intensive care unit (MICU) of General Hospital of Guangzhou Military Command from March 2014 to December 2015 and experiencing critical care over 48 hours were enrolled. Age, gender, acute physiology and chronic health evaluation II (APACHE II) score, sequential organ failure assessment (SOFA) score and AGI score at admission (SOFAinitial, AGIinitial), the highest SOFA score and AGI score within the first week (SOFAmax, AGImax), serum procalcitonin (PCT), C-reactive protein (CRP), albumin (ALB), platelet (PLT), hemoglobin (Hb) and lactate (Lac) levels, length of ICU stay, usage of mechanical ventilation and renal replacement therapy were recorded. The primary end point was 28-day mortality. To extract factors affecting 28-day mortality, the risk factor of death of the senile sepsis patients were analyzed by binary logistic regression analysis (stepwise method). Fitness of the model was assessed by the Hosmer-Lemeshow test and calibration plot (P > 0.05). Receiver operating characteristic (ROC) analysis was performed for APACHE II score, SOFAinitial score, SOFAmax score, AGIinitial score, AGImax score and SOFAmax and combined AGImax score. Ninety-one patients were enrolled, the incidence of AGI in elderly patients with sepsis was 100%; 34 patients died 28 days after the admission, and the 28-day mortality rate was 37.4%. Non-survivors presented a higher APACHE II score, SOFAinitial score, SOFAmax score, AGIinitial score, AGImax score and longer usage of mechanical ventilation and renal replacement therapy. SOFAmax score [odds ratio (OR) = 1.576] and AGImax score (OR = 5.695) were associated with 28-day mortality in binary logistic regression analysis (both P < 0.01). The area under the curve (AUC) and 95% confidence interval (95%CI) of SOFAmax score combined AGImax score was significantly higher than that of SOFAinitial score, SOFAmax score, AGIinitial score, AGImax score and APACHE II score [0.806 (0.710-0.881) vs. 0.723 (0.619-0.812), 0.786 (0.688-0.865), 0.641 (0.533-0.739), 0.633 (0.526-0.881), 0.638 (0.531-0.736), all P < 0.05]. The Youden index (55.37) and positive predict value (5.51) of SOFAmax score combined AGImax score were the largest. When its cut-off value reached 14, the sensitivity and specificity was 67.65% and 87.72%, respectively. According to score of APACHE II, SOFAinitial, SOFAmax or AGImax, the higher of each score, the higher mortality rate could be. The combination of SOFAmax score and AGImaxscore enable accurate prediction in elderly patients with sepsis.

Establishment of prediction model of acute gastrointestinal injury classification of critically ill patients based on digital gastrointestinal sounds monitoring

To develop the prediction model of acute gastrointestinal injury (AGI) classification of critically ill patients. The binary channel gastrointestinal sounds (GIS) monitor system was used to gather and analyze the GIS of 60 consecutive critically ill patients who were admitted in Critical Care Medicine of PLA General Hospital from April 2015 to November 2015 (patients with chronic gastrointestinal disease or history of gastrointestinal surgery were excluded). Meanwhile, the AGI grades were evaluated according to the ESICM guidelines of AGI grading system. Correlations between GIS and AGI classification were examined with Spearman rank correlation. Then principal component analysis was performed on the significantly correlated parameters after standardization. The top 3 post-normalized main components were selected for back-propagation (BP) neural network training to establish primary AGI grade model of critically ill patients based on the neural network model. A total of 1 132 GIS and 333 AGI were collected from 60 patients. The number (P = 0.0005), percentage of time (P = 0.0004), mean power (P = 0.0088), maximum power (P = 0.0101) and maximum time (P = 0.0025) of GIS wave from the channel located at the stomach were negatively correlated with the AGI grades, while the parameters of GIS wave from the channel located at the intestine had no significant correlation with the AGI grades(all P > 0.05). Three main components were selected after principal component analysis of these five correlated parameters. An AGI grade network model including 9 hide layers, with a fitting degree of 0.981 64 was built by BP artificial neural network based on the analysis of these three main components of GIS. The accuracy rate of the model to predict the AGI grade was 70.83%. The preliminary model based on GIS in classifying AGI grade is established successfully, which can help predict the classification of AGI grade of critically ill patients.

Omega-3 Fish Oil Reduces Mortality Due to Severe Sepsis with Acute Gastrointestinal Injury Grade III.

Background:Sepsis plays an important role in acute gastrointestinal injury (AGI). Our research was designed to determine the effects of omega-3 fish oil (FO) in patients suffering from severe sepsis combined with AGI III, and the ability of FO to modulate immune function.Methods:Seventy-eight patients diagnosed with severe sepsis with AGI III and a need for mechanical ventilation were randomized to two groups. In the FO group, 50 g of long chain fatty acid soybean oil (n = 6) and 10 g of FO (n = 3) were administered as total parenteral nutrition (TPN). The control group was treated with 50 g of long chain fatty acid soybean oil without addition of FO to TPN.Results:At baseline, there were no significant differences between the two groups. The 60-day mortality was lower in the FO group. Multiple factor logistic regression analysis revealed that intra-abdominal pressure (IAP) and abdominal infection were correlated with the FO intervention. The patients with abdominal infection demonstrated a lower mortality rate, fewer CD3 T lymphocytes, and fewer helper/inducer T lymphocytes in the FO group compared with the control group. After 7 days, the Marshall Score was lower in the FO group than in the control group.Conclusion:FO has positive effects in terms of improving the long-term prognosis of patients with severe sepsis with AGI III. Patients with a high IAP and abdominal infection might experience greater benefit from FO. This effect might be due, in part, to immunomodulation.SUMMARY Fish oil (FO) has positive effects in terms of improving the long-term prognosis of patients with severe sepsis with acute gastrointestinal injury Grade IIIPatients with a high intra-abdominal pressure and abdominal infection might experience greater benefit from FOThis effect might be due, in part, to immunomodulation. Abbreviations used: AGI: Acute gastrointestinal injury; FO: Fish oil; TPN: Total parenteral nutrition; IAP: Intra-abdominal pressure; ICU: Intensive Care Unit; MODS: Multiple organ dysfunction syndrome; TLR4: Toll-like receptor 4; DNR: Do Not Resuscitate; WGAP: Working Group of Abdominal Problem; EN: Enteral nutrition; BP: Low blood pressure; CRI: Catheter-related infection; PBS: Phosphate-buffered saline; ELFA: Enzyme-linked fluorescent assay; SD: Standard deviation; PUFAs: Polyunsaturated fatty acids; EPA: Eicosapentenoic acid; DHA: Docosahexaenoic acid.

Function of early enteral nutrition in patients with acute gastrointestinal injury and severe craniocerebral injury

Objective To observe the occurrence and related factors of acute gastrointestinal injury (AGI) in patients with severe craniocerebral injury, to discuss the feasibility of early enteral nutrition (EN) after AGI, and to explore the relationship between clinical outcome and early EN. Methods We collected the clinical data of 86 patients with severe craniocerebral injury, including gender, age, presence and grading of AGI, Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ score, Glasgow coma scale (GCS), mortality, the rate of EN within 24 hours, and 7-day standard energy intake rate. The patients were divided into four groups according to AGI grading, i. e. grade Ⅰ, Ⅱ, Ⅲ, and Ⅳ, and compared in terms of gender, age, APACHE Ⅱ score, GCS, mortality, 24-hour EN rate, and 7-day standard energy intake rate. The patients were divided into two groups according to the clinical outcome (death or survival), and compared in terms of GCS, 24-hour EN rate, and 7-day standard energy intake rate. Results AGI occurred in all the 86 patients with severe craniocerebral injury, and the number of patients in grade Ⅰ, Ⅱ, Ⅲ, Ⅳ were 30, 26, 21, 9, respectively. Among the four groups according to AGI grading, there were statistical differences in APACHE Ⅱ score, GCS, and mortality (P<0.05 or P<0.01). The more severe the gastrointestinal dysfunction, the higher the APACHE Ⅱ score and mortality, and the lower the GCS score. There were statistical differences in the rate of 24-hour EN and 7-day standard energy intake rate among the four groups of AGI grading (P<0.01), with both rates decreasing with more severe gastrointestinal dysfunction. Among the two groups according to different clinical outcome, the rate of 24-hour EN, 7-day standard energy intake rate and GCS score were significantly lower in the death group than in the survival group (all P<0.01). Correlation analysis showed that there was a negative correlation between mortality and the rate of 24-hour EN (r=-0.478, P<0.01), 7-day standard energy intake (r=-0.795, P<0.01), and GCS score (r=-0.638, P<0.01). Conclusion AGI may be closely associated with severe craniocerebral injury. For patients with craniocerebral injury, especially severe injury, the gastrointestinal function should be estimated for timely application of effective nutrition support to improve patient outcome through correcting metabolic disturbance and negative nitrogen balance. Key words: Craniocerebral injury; Acute gastrointestinal injury; Mortality

Association between acute gastrointestinal injury grading system and disease severity and prognosis in critically ill patients: A multicenter, prospective, observational study in China

PurposeThis prospective study investigated the association between disease severity and acute gastrointestinal injury (AGI) grade and between prognosis and AGI. MethodsIn 12 teaching hospitals in China, patients in intensive care units who had received a diagnosis of AGI were enrolled (N = 196). Their demographics, body mass index, Acute Physiology and Chronic Health Evaluation II score, Sepsis-related Organ Failure Assessment score, mechanical ventilation, acute kidney injury, intensive care unit stay, and 7-day and 28-day mortality were recorded. ResultsOf the 196 AGI patients, 90, 64, 29, and 13 were classified as grades I, II, III, and IV, respectively. Acute Physiology and Chronic Health Evaluation II scores independently predicted grades III and IV; acute kidney injury independently predicted grade III. The 28-day mortality rates of grades I and II were similar, as were those of grades III and IV. The mortality rate of patients with grades I + II (gastrointestinal dysfunction) was significantly lower than that of patients with grades III + IV (gastrointestinal failure). ConclusionDifferentiating AGI as gastrointestinal dysfunction or gastrointestinal failure appears to be more valid for predicting prognosis than the AGI 4-grade system.

Predictive value of AGI grading system introduced into SOFA score in patients with severe acute pancreatitis

Objective To study the predictive value of acute gastrointestinal injury (AGI) grading system introduced into Sequential Organ Failure Assessment (SOFA) score in patients with severe acute pancreatitis (SAP) in order to provide a reliable clinical tool for the evaluation of prognosis of SAP. Methods Patients with acute pancreatitis admitted to ICU from July 2012 to July 2014 were enrolled for study. The criteria of exclusion were the age below 18 years old, pregnancy, or patients without consent to the treatment. A total of 63 patients with 37 males and 26 females aged (47 ±15.3) years were included. The data of their acute physiology and chronic health evaluation (APACHE) Ⅱ score, the highest SOFA score and AGI grade within the first week, and the 28-day mortality rate were collected. Patients without AGI were defined as zero point, and AGI grade I -IV were defined as 1-4 points. The receiver operating characteristic curve (ROC) was used to evaluate the value of APACHEⅡ score, SOFA score, and SOFA + AGI score in predicting the prognosis of SAP. The areas under ROC curve (AUC) of the APACHEⅡ score, SOFA score, and SOFA +AGI score were compared with MedCalc software, and P value less than 0.01 was considered to be statistical significance. Results (1) The 28-day mortality of the 63 patients with SAP was 20.6% (13/63), in which 50 patients in the survival group, 13 patients in the death group. The APACHEⅡ scores of two groups were (15.62 ± 4.33 vs. 12.10 ± 3.74, P =0.0048), the SOFA scores were (14.77 ± 3.09 vs. 9.24 ± 2.88, P <0.01), and the SOFA +AGI scores were (18.77 ± 3.09 vs. 10.74 ± 3.17, P <0.01). (2) The AUC of APACHEⅡ score was 0.748 ± 0.084 (95% CI: 0.622-0.849), the AUC of SOFA score was 0.902 ± 0.059 (95% CI: 0.801-0.962), and the AUC of SOFA +AGI score was 0.963 ± 0.037 (95% CI, 0.882-0.994) ; There was no significant difference in AUC between APACHEⅡ score and SOFA score (P =0.10) , and there was statistical significance between the AUC of APACHEⅡ score and that of SOFA +AGI score (P =0.013) , and the difference in AUC between SOFA score and SOFA +AGI score was statistically significant (P =0.008). The Youden index and the positive likelihood ratio of SOFA +AGI score system were the greatest to be 0.863 and 15.38, respectively. Conclusions SOFA scoring system has better predictive value in patients with SAP when AGI grading system was introduced into it. Key words: Acute gastrointestinal injury grading system; APACHEⅡ score; SOFA score; Severe acute pancreatitis; Prognosis

Does elevated intra-abdominal pressure during laparoscopic colorectal surgery cause acute gastrointestinal injury?

IntroductionThe incidence of acute gastrointestinal injury (AGI) after colorectal surgery is low when laparoscopic techniques are used. While elevated intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) are associated with AGI grade II, little is known about the relation between increased IAP during laparoscopy and subsequent AGI.AimTo assess the impact of increased IAP during laparoscopic colorectal surgery on the incidence of postoperative AGI.Material and methodsSixty-six patients (41 men and 25 women) with colorectal cancer undergoing elective laparoscopic colorectal surgery were randomized into 3 groups, according to different IAP levels during CO2 pneumoperitoneum (10 mm Hg, 12 mm Hg and 15 mm Hg). We recorded the incidence of AGI after surgery by assessing the following parameters: time to first flatus/defecation, time to first bowel movement, time to tolerance of semi-liquid food and the occurrence of vomiting/diarrhea. Moreover, inflammatory mediators were measured before the induction of CO2 pneumoperitoneum and on postoperative day 1.ResultsAcute gastrointestinal injury occurred in 15 (27.3%) patients. In all 3 study groups, the elevation of IAP during CO2 pneumoperitoneum did not significantly increase the occurrence of symptoms of AGI, vomiting or diarrhea. Lower IAP levels did not significantly accelerate recovery of gastrointestinal function or shorten postoperative hospital stay. The changes in serum IL-6 after surgery did not correlate with the value of IAP.ConclusionsThe level of IAP elevation during laparoscopic colorectal surgery does not increase the occurrence of AGI after surgery.

Comparison of two nasal-jejunal tube placement methods in critically ill patients with different acute gastrointestinal injury grades

Comparison of two nasal-jejunal tube placement methods in critically ill patients with different acute gastrointestinal injury grades

Correlation of intestinal fatty acid binding protein and intestinal injury in severe sepsis

To investigate the content of intestinal fatty acid binding protein (IFABP) and its clinical significance in patients with severe sepsis. A prospective observational study was conducted. Fifty patients with severe sepsis admitted to intensive care unit (ICU) of the First Affiliated Hospital of China Medical University from July to December 2012 were enrolled, and 20 healthy patients served as control group. The concentrations of serum IFABP, interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) were determined with enzyme-linked immunosorbent assay (ELISA) on days 0, 1 and 3 after ICU admission. Acute physiology and chronic health evaluation II (APACHEII) and sequential organ failure assessment (SOFA) score, 28-day prognosis, acute gastrointestinal injury (AGI) grade were recorded at the same time. Furthermore, the contents of IFABP were compared between control group and the severe sepsis group, abdominal infection group and non-abdominal infection group, the survival group and the death group, as well as among different AGI-grade groups. Correlation analysis of IFABP and inflammatory factors, IFABP and two scores, and IFABP and time of stay in ICU and mechanical ventilation were studied. Multivariate logistic regression and analysis of 28-day outcome of the patients were also studied. IFABP levels were increased in severe sepsis patients on days 0, 1 and 3 compared with those of healthy control group (731.90±53.91 mg/L, 592.07 ± 41.94 mg/L, 511.85 ± 47.97 mg/L vs. 439.88 ± 23.68 mg/L, all P=0.000). There was no statistical significance of IFABP levels between abdominal infection group and non-abdominal infection group, the survival group and the death group, or among different AGI-grade groups. The correlation analysis showed that IFABP was statistically related with IL-6 (r=0.794, P=0.000), TNF-α (r=0.878, P=0.010), APACHEII score (r=0.428, P=0.000) in patients with severe sepsis. Significant correlations were also found between IFABP and IL-6 (r=0.812, P=0.000), TNF-α (r=0.885, P=0.000) in abdominal infection group, as well as in non-abdominal infection group (IL-6: r=0.739, P=0.000; TNF-α: r=0.828, P=0.000). As shown by multivariate logistic regression analysis, SOFA scores on days 0, 1, 3 were the independent risk factors for death [odds ratio (OR) was 1.624 (P=0.004), 1.411 (P=0.027), 1.740 (P=0.012), respectively], but IFABP level, AGI grade, and APACHEII score had no influence on death rate. IFABP concentrations in patients with severe sepsis were significantly increased, and it is correlated well to IL-6, TNF-α and APACHEII score, but did not related obviously with AGI grade and the prognosis of the patients.

Evaluation of clinical application of ESICM acute gastrointestinal injury grading system: a single-center observational study

Background In 2012, the working group on abdominal problems of the European Society of Intensive Care Medicine (ESICM) proposed a definition and also guidelines for the grading system and treatment of acute gastrointestinal injury (AGI). Until now, clinical reports on this topic have not been available, and the practicality of using the AGI grading system requires further validation in the clinic. Therefore, we conducted this study to evaluate the feasibility of utilizing the current AGI grading system in a clinical environment, and to provide evidence for its usefulness in assessing the severity and prognosis of critically ill patients with gastrointestinal dysfunction. Methods A total of 133 patients were examined for the presence or absence of AGI, their scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and Lausanne Intestinal Failure Estimation (LIFE) test, and 28 days mortality. The presence and severity of AGI was based on guidelines provided by the ESICM. The patients were assigned to a NO-AGI group (n=50) or an AGI group (n=83). The AGI group was then further divided into three subgroups, consisting of AGI I (risk group, n=38), AGI II (gastrointestinal dysfunction group, n=33) and AGI III+AGI IV (gastrointestinal failure group, n=12). These subgroups were then compared for differences in AGI indicators. Results There were no statistically significant differences between the AGI group and the NO-AGI group in terms of age, gender, APACHE II score or LIFE score (P &gt; 0.05); however, the two groups showed a significant difference in their respective rates of 28 days mortality (32.5% in the AGI group vs. 8.0% in the NO-AGI group (P &lt; 0.05)). Patients in the three AGI subgroups showed significant differences in their 28 d mortality rates, APACHE II, and LIFE scores. AGI grading system showed strong positive correlations with APACHE II and LIFE scores (P &lt; 0.05). Conclusions The current AGI grading system can be used to identify and evaluate gastrointestinal dysfunction in critically ill patients, and also to provide a preliminary assessment regarding the prognosis for patients with different grades of AGI. Chin Med J 2014;127 (10): 1833-1836

Value of acute gastrointestinal injury grading system in assessing gastrointestinal dysfunction in critically ill patients: Application in early enteral nutrition

Value of acute gastrointestinal injury grading system in assessing gastrointestinal dysfunction in critically ill patients: Application in early enteral nutrition

Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems.

PurposeAcute gastrointestinal (GI) dysfunction and failure have been increasingly recognized in critically ill patients. The variety of definitions proposed in the past has led to confusion and difficulty in comparing one study to another. An international working group convened to standardize the definitions for acute GI failure and GI symptoms and to review the therapeutic options.MethodsThe Working Group on Abdominal Problems (WGAP) of the European Society of Intensive Care Medicine (ESICM) developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology.ResultsDefinitions for acute gastrointestinal injury (AGI) with its four grades of severity, as well as for feeding intolerance syndrome and GI symptoms (e.g. vomiting, diarrhoea, paralysis, high gastric residual volumes) are proposed. AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness. AGI grade I = increased risk of developing GI dysfunction or failure (a self-limiting condition); AGI grade II = GI dysfunction (a condition that requires interventions); AGI grade III = GI failure (GI function cannot be restored with interventions); AGI grade IV = dramatically manifesting GI failure (a condition that is immediately life-threatening). Current evidence and expert opinions regarding treatment of acute GI dysfunction are provided.ConclusionsState-of-the-art definitions for GI dysfunction with gradation as well as management recommendations are proposed on the basis of current medical evidence and expert opinion. The WGAP recommends using these definitions for clinical and research purposes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00134-011-2459-y) contains supplementary material, which is available to authorized users.