Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2020; 26(5): 514-523
Published online Feb 7, 2020. doi: 10.3748/wjg.v26.i5.514
Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis
Ling Ding, Hong-Yan Chen, Jin-Yun Wang, Hui-Fang Xiong, Wen-Hua He, Liang Xia, Nong-Hua Lu, Yin Zhu
Ling Ding, Hong-Yan Chen, Jin-Yun Wang, Hui-Fang Xiong, Wen-Hua He, Liang Xia, Nong-Hua Lu, Yin Zhu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Ding L and Chen HY designed the study, collected the data, and wrote the manuscript; Wang JY helped in collecting the data; Xiong HF conceived of the study and participated in its design; He WH and Xia L helped in analyzing the data; Lu NH and Zhu Y made substantial contributions to conception, design, and coordination of the study and gave final approval of the version to be published; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81760120.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: All involved subjects gave their informed consent (written or verbal) prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
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:
Corresponding author: Yin Zhu, PhD, Chief Doctor, Professor of Medicine, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China.
Received: December 3, 2019
Peer-review started: December 3, 2019
First decision: December 23, 2019
Revised: January 7, 2020
Accepted: January 15, 2020
Article in press: February 7, 2020
Published online: February 7, 2020
Research background

Gastrointestinal (GI) dysfunction is a common complication of acute pancreatitis (AP), especially in severe AP. Due to a lack of a precise definition of GI dysfunction, there is little data regarding the prognostic value of GI dysfunction in AP patients.

Research motivation

We wanted to determine the feasibility of using acute gastrointestinal injury (AGI) grade to evaluate GI function in critically ill patients with AP, and investigate the association between AGI grades and clinical outcomes.

Research objectives

To evaluate the relationship between AGI grade and mortality in critically ill patients with AP, and to investigate the prognostic value of AGI grade alone and in combination with other severity scores in AP patients.

Research methods

A retrospective cohort study was conducted, and 286 patients were included and divided to four groups according to AGI grades. A Kaplan-Meier survival analysis was performed to estimate the cumulative survival. Logistic regression analysis (stepwise regression) was used to identify independent risk factors.

Research results

The distribution of patients with various AGI grades was 34.62% with grade I, 22.03% with grade II, 32.52% with grade III, and 10.84% with grade IV. AGI grade was positively correlated with mortality, and was an independent risk factor for mortality. Compared with the APACHE II score and Ranson score, the AGI grade was more useful for predicting mortality. The combinations of AGI grade and APACHE II score [area under curve (AUC): 0.893], Modified Marshall score (AUC: 0.895), or Ranson score (AUC: 0.89) exhibited greater predictive values that were superior to any of these scoring systems used alone.

Research conclusions

The AGI grade is feasible for evaluating GI function in critically ill patients with AP, and is an independent predictor of mortality. The AGI grade combined with the APACHE II, Modified Marshall, and Ranson scores allows better prediction of mortality than does the use of any of these scoring systems alone.

Research perspectives

GI dysfunction has an adverse effect on the prognosis, and AGI grade may be an available evaluation tool. We hope that a future prospective study may focus on the development of new biochemical indicators and scoring systems for the evaluation of GI dysfunction.