Published online Feb 7, 2020. doi: 10.3748/wjg.v26.i5.514
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
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.
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.
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.
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.
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.
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.
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.