危重症患者胃肠功能障碍评分（GIDS）的制定——一项前瞻性多中心观察性研究（iSOFA研究）

Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients - A prospective multicenter observational study (iSOFA study).

作者信息

Reintam Blaser Annika, Padar Martin, Mändul Merli, Elke Gunnar, Engel Christoph, Fischer Krista, Giabicani Mikhael, Gold Thomas, Hess Benjamin, Hiesmayr Michael, Jakob Stephan M, Loudet Cecilia I, Meesters Dennis M, Mongkolpun Wasineenart, Paugam-Burtz Catherine, Poeze Martijn, Preiser Jean-Charles, Renberg Mattias, Rooijackers Olav, Tamme Kadri, Wernerman Jan, Starkopf Joel

机构信息

Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland.

Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, Tartu University Hospital, Tartu, Estonia.

出版信息

Clin Nutr. 2021 Aug;40(8):4932-4940. doi: 10.1016/j.clnu.2021.07.015. Epub 2021 Jul 18.

DOI:10.1016/j.clnu.2021.07.015

PMID:34358839

Abstract

BACKGROUND & AIMS: To develop a five grade score (0-4 points) for the assessment of gastrointestinal (GI) dysfunction in adult critically ill patients.

METHODS

This prospective multicenter observational study enrolled consecutive adult patients admitted to 11 intensive care units in nine countries. At all sites, daily clinical data with emphasis on GI clinical symptoms were collected and intra-abdominal pressure measured. In five out of 11 sites, the biomarkers citrulline and intestinal fatty acid-binding protein (I-FABP) were measured additionally. Cox models with time-dependent scores were used to analyze associations with 28- and 90-day mortality. The models were estimated with stratification for study center.

RESULTS

We included 540 patients (224 with biomarker measurements) with median age of 65 years (range 18-94), the Simplified Acute Physiology Score II score of 38 (interquartile range 26-53) points, and Sequential Organ Failure Assessment (SOFA) score of 6 (interquartile range 3-9) points at admission. Median ICU length of stay was 3 (interquartile range 1-6) days and 90-day mortality 18.9%. A new five grade Gastrointestinal Dysfunction Score (GIDS) was developed based on the rationale of the previously developed Acute GI Injury (AGI) grading. Citrulline and I-FABP did not prove their potential for scoring of GI dysfunction in critically ill. GIDS was independently associated with 28- and 90-day mortality when added to SOFA total score (HR 1.40; 95%CI 1.07-1.84 and HR 1.40; 95%CI 1.02-1.79, respectively) or to a model containing all SOFA subscores (HR 1.48; 95%CI 1.13-1.92 and HR 1.47; 95%CI 1.15-1.87, respectively), improving predictive power of SOFA score in all analyses.

CONCLUSIONS

The newly developed GIDS is additive to SOFA score in prediction of 28- and 90-day mortality. The clinical usefulness of this score should be validated prospectively.

TRIAL REGISTRATION

NCT02613000, retrospectively registered 24 November 2015.

摘要

背景与目的

制定一个五级评分（0 - 4分），用于评估成年危重症患者的胃肠道（GI）功能障碍。

方法

这项前瞻性多中心观察性研究纳入了连续入住9个国家11个重症监护病房的成年患者。在所有研究点，收集每日临床数据，重点关注胃肠道临床症状，并测量腹内压。在11个研究点中的5个，还额外测量了生物标志物瓜氨酸和肠脂肪酸结合蛋白（I-FABP）。使用具有时间依赖性评分的Cox模型分析与28天和90天死亡率的相关性。模型估计时对研究中心进行了分层。

结果

我们纳入了540例患者（224例测量了生物标志物），中位年龄65岁（范围18 - 94岁），入院时简化急性生理学评分II为38分（四分位间距26 - 53分），序贯器官衰竭评估（SOFA）评分为6分（四分位间距3 - 9分）。重症监护病房中位住院时间为3天（四分位间距1 - 6天），90天死亡率为18.9%。基于先前制定的急性胃肠损伤（AGI）分级原理，开发了一种新的五级胃肠功能障碍评分（GIDS）。瓜氨酸和I-FABP在危重症患者胃肠道功能障碍评分中未显示出其潜力。当GIDS加入SOFA总分（风险比1.40；95%置信区间1.07 - 1.84和风险比1.40；95%置信区间1.02 - 1.79，分别）或包含所有SOFA子评分的模型（风险比1.48；95%置信区间1.13 - 1.92和风险比1.47；95%置信区间1.15 - 1.87，分别）时，与28天和90天死亡率独立相关，在所有分析中提高了SOFA评分的预测能力。