Shen C, Wang X, Xiao YY, Zhang JY, Xia GL, Jiang RL. Comparing gastrointestinal dysfunction score and acute gastrointestinal injury grade for predicting short-term mortality in critically ill patients. World J Gastroenterol 2024; 30(42): 4523-4531 [DOI: 10.3748/wjg.v30.i42.4523]
Corresponding Author of This Article
Rong-Lin Jiang, MS, Chief Doctor, Professor, Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. jiangronglin@126.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Chao Shen, Xi Wang, Yi-Ying Xiao, Jia-Ying Zhang, Guo-Lian Xia, Rong-Lin Jiang, Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), Hangzhou 310006, Zhejiang Province, China
Co-first authors: Chao Shen and Xi Wang.
Author contributions: Shen C, Wang X and Xia GL carried out the studies, participated in collecting data; Shen C and Wang X drafted the manuscript; Zhang JY and Xiao YY performed the statistical analysis and participated in its design; Jiang RL designed the study, and revised the manuscript. All authors read and approved the final manuscript. Shen C and Wang X contributed equally to this study.
Institutional review board statement: The study protocol was approved by the Ethics Committee of the First Affiliated Hospital of Zhejiang Chinese Medical University (No. 2024-KLS-369-02).
Informed consent statement: The need for patient consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Rong-Lin Jiang, MS, Chief Doctor, Professor, Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Traditional Chinese Medicine), No. 54 Youdian Road, Shangcheng District, Hangzhou 310006, Zhejiang Province, China. jiangronglin@126.com
Received: July 29, 2024 Revised: September 24, 2024 Accepted: October 18, 2024 Published online: November 14, 2024 Processing time: 94 Days and 6.2 Hours
Abstract
BACKGROUND
The prognosis of critically ill patients is closely linked to their gastrointestinal (GI) function. The acute GI injury (AGI) grading system, established in 2012, is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings. In 2021, the GI dysfunction score (GIDS) was developed, building on the AGI grading system, to enhance the accuracy of GI dysfunction severity assessment, improve prognostic predictions, reduce subjectivity, and increase reproducibility.
AIM
To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.
METHODS
A retrospective study was conducted at the general intensive care unit (ICU) of a regional university hospital. All data were collected during the first week of ICU admission. The primary outcome was 28-day mortality. Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality. The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve, with DeLong’s test assessing differences between the curves’ areas.
RESULTS
The incidence of AGI in the first week of ICU admission was 92.13%. There were 85 deaths (47.75%) within 28 days of ICU admission. There was no initial 24-hour difference in GIDS between the non-survival and survival groups. Both GIDS (OR 2.01, 95%CI: 1.25-3.24; P = 0.004) and AGI grade (OR 1.94, 95%CI: 1.12-3.38; P = 0.019) were independent predictors of 28-day mortality. No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission (Z = -0.26, P = 0.794).
CONCLUSION
GIDS within the first 24 hours was an unreliable predictor of 28-day mortality. The predictive accuracy for 28-day mortality from both systems during the first week was comparable.
Core Tip: Gastrointestinal (GI) function plays a crucial role in the prognosis of critically ill patients. The acute GI injury (AGI) grade and GI dysfunction score (GIDS) are valuable tools for assessing the severity of GI dysfunction and predicting mortality in this patient population. Our study revealed that both GIDS and AGI grade during the first week of intensive care unit (ICU) admission independently predicted 28-day mortality. However, GIDS within the first 24 hours did not prove to be a reliable predictor. The ability to predict 28-day mortality based on the maximum values of GIDS and AGI grade during the initial week of ICU admission was comparable.
