ICU, Zhejiang Provincial People's Hospital, 158 Shangtang Road, Hangzhou, 310014, China.
ICU, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 East Qingchun Road, Hangzhou, Zhejiang, China.
Crit Care. 2017 Jul 14;21(1):188. doi: 10.1186/s13054-017-1780-4.
In 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.
Adult 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.
Among 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 (χ = 41.9 vs. 52.2, P = 0.007).
The 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.
Chinese Clinical Trial Registry identifier: ChiCTR-OCS-13003824 . Registered on 29 September 2013.
2012 年，欧洲危重病医学会基于现有医学证据和专家意见提出了急性胃肠损伤（AGI）的定义。本研究旨在评估当前 AGI 分级系统的可行性，并研究 AGI 严重程度与危重症患者临床结局之间的关系。
本前瞻性研究纳入了 14 个普通重症监护病房（ICU）中预计 ICU 住院时间≥24 小时的成年患者。在 ICU 入住的第一周，根据胃肠道（GI）症状、腹腔内压和喂养不耐受（FI）情况，每日评估 AGI 分级。
在纳入的 550 例患者中，456 例（82.9%）接受了机械通气，470 例患者符合 AGI 分级标准。总体 AGI 分级分布为：I 级 24.5%，II 级 49.4%，III 级 20.6%，IV 级 5.5%。AGI 分级与 28 天和 60 天死亡率呈正相关（P<0.0001）。单因素 Cox 回归分析显示，年龄、脓毒症、糖尿病、冠状动脉疾病、血管活性药物的使用、血清肌酐和乳酸水平、机械通气、急性生理学和慢性健康评估 II（APACHE II）评分和总体 AGI 分级与 60 天死亡率显著相关（P≤0.02）。在包括这些变量的多因素分析中，糖尿病（HR 1.43，95%CI 1.03-1.87；P=0.05）、血管活性药物的使用（HR 1.56，95%CI 1.12-2.11；P=0.01）、血清乳酸（HR 1.15，95%CI 1.06-1.24；P=0.03）、总体 AGI 分级（HR 1.65，95%CI 1.28-2.12；P=0.008）和 APACHE II 评分（HR 1.04，95%CI 1.02-1.06；P<0.001）与 60 天死亡率独立相关。在 402 例 7 天存活患者的亚组分析中，除了临床预测因素和 ICU 入住第一天的 AGI 分级外，ICU 入住第一周内的 FI 对 60 天死亡率具有独立且增量的预后价值（χ2=41.9 与 52.2，P=0.007）。
AGI 分级方案可用于识别胃肠道功能障碍的严重程度，并可作为预后不良的预测指标。此外，这些结果支持这样的假设，即 ICU 入住第一周内持续的 FI 是死亡率的独立决定因素。
中国临床试验注册中心标识符：ChiCTR-OCS-13003824。注册于 2013 年 9 月 29 日。
