Moore S, Donlon NE. Improving gastrointestinal scoring systems for predicting short-term mortality in critically ill patients. World J Gastroenterol 2025; 31(5): 102622 [PMID: 39926223 DOI: 10.3748/wjg.v31.i5.102622]
Corresponding Author of This Article
Noel E Donlon, PhD, Assistant Professor, Department of Upper Gastrointestinal Surgery, St James Hospital, James Street, Dublin D09, Leinster, Ireland. donlonn@tcd.ie
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Letter to the Editor
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/
World J Gastroenterol. Feb 7, 2025; 31(5): 102622 Published online Feb 7, 2025. doi: 10.3748/wjg.v31.i5.102622
Improving gastrointestinal scoring systems for predicting short-term mortality in critically ill patients
Shane Moore, Noel E Donlon
Shane Moore, Department of Anaesthesia and Critical Care, University Hospital Limerick, Limerick V94, Munster, Ireland
Noel E Donlon, Department of Upper Gastrointestinal Surgery, St James Hospital, Dublin D09, Leinster, Ireland
Author contributions: Moore S wrote and revised the manuscript; Donlon NE devised the concept, content, and assisted in drafting and redrafting the manuscript.
Conflict-of-interest statement: Both authors declare no conflict of interest.
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: Noel E Donlon, PhD, Assistant Professor, Department of Upper Gastrointestinal Surgery, St James Hospital, James Street, Dublin D09, Leinster, Ireland. donlonn@tcd.ie
Received: October 24, 2024 Revised: November 24, 2024 Accepted: November 29, 2024 Published online: February 7, 2025 Processing time: 68 Days and 0.6 Hours
Abstract
Shen et al’s retrospective study aims to compare the utility of two separate scoring systems for predicting mortality attributable to gastrointestinal (GI) injury in critically ill patients [the GI Dysfunction Score (GIDS) and the Acute Gastrointestinal Injury (AGI) grade]. The authors note that this study is the first proposal that suggests an equivalence between the ability of both scores to predict mortality at 28 days from intensive care unit (ICU) admission. Shen et al retrospectively analysed an ICU cohort of patients utilising two physicians administering both the AGI grade and GIDS score, using electronic healthcare records and ICU flowsheets. Where these physicians disagreed about the scores, the final decision as to the scores was made by an associate chief physician, or chief physician. We note that the primary reason for the development of GIDS was to create a clear score for GI dysfunction, with minimal subjectivity or inter-operator variability. The subjectivity inherent to the older AGI grading system is what ultimately led to the development of GIDS in 2021. By ensuring consensus between physicians administering the AGI, Shen et al have controlled for one of this grading systems biggest issues. We have concerns, however, that this does not represent the real-world challenges associated with applying the AGI compared to the newer GIDS, and wonder if this arbitration process had not been instituted, would the two scoring systems remain equivalent in terms of predicted mortality?
Core Tip: In order to ensure the feasible application of scoring systems in critically ill patients, they must be simplistic and pragmatic to ensure transferability from an academic setting to clinical implementation. We propose such a modification of the current system forthwith.
