Observational Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Dec 27, 2024; 16(12): 3818-3834
Published online Dec 27, 2024. doi: 10.4240/wjgs.v16.i12.3818
Diagnostic value of digital continuous bowel sounds in critically ill patients with acute gastrointestinal injury: A prospective observational study
Yuan-Hui Sun, Yun-Yun Song, Sha Sha, Qi Sun, Deng-Chao Huang, Lan Gao, Hao Li, Qin-Dong Shi
Yuan-Hui Sun, Yun-Yun Song, Sha Sha, Qi Sun, Deng-Chao Huang, Lan Gao, Hao Li, Qin-Dong Shi, Department of Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shaanxi Province, China
Yuan-Hui Sun, Lan Gao, Hao Li, Qin-Dong Shi, Shaanxi Province Key Laboratory of Sepsis in Critical Care Medical, Xi'an 710061, Shaanxi Province, China
Author contributions: Sun YH was a co-contributor to the study design and the data acquisition, analysis, and interpretation, and drafted the manuscript; Song YY, Sha S, Sun Q, and Huang DC were co-contributors to data acquisition and analysis; Gao L and Li H were co-contributors to the revision of the manuscript; Shi QD was a co-contributor to the study design, interpretation of the data, and drafting of the manuscript; all of the authors read and approved the final version of the manuscript to be published.
Supported by The Clinical Research Center of the First Affiliated Hospital of Xi'an Jiaotong University, No. XJTU1AF2021CRF-018.
Institutional review board statement: This study was reviewed and approved by the Medical Ethics Committee of The First Affiliated Hospital of Xi’an Jiaotong University (Approval No. XJTU1AF2021LSK-013).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: The data used for this research are available from the corresponding author on reasonable request and subject to Institutional Review Board guidelines.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Qin-Dong Shi, MD, PhD, Doctor, Professor, Department of Critical Care Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, No. 277 West Yanta Road, Yanta District, Xi’an 710061, Shaanxi Province, China. shiqindong@163.com
Received: April 12, 2024
Revised: September 5, 2024
Accepted: October 22, 2024
Published online: December 27, 2024
Processing time: 228 Days and 17.4 Hours
Abstract
BACKGROUND

Acute gastrointestinal injury (AGI) is common in intensive care unit (ICU) and worsens the prognosis of critically ill patients. The four-point grading system proposed by the European Society of Intensive Care Medicine is subjective and lacks specificity. Therefore, a more objective method is required to evaluate and determine the grade of gastrointestinal dysfunction in this patient population. Digital continuous monitoring of bowel sounds and some biomarkers can change in gastrointestinal injuries. We aimed to develop a model of AGI using continuous monitoring of bowel sounds and biomarkers.

AIM

To develop a model to discriminate AGI by monitoring bowel sounds and biomarker indicators.

METHODS

We conducted a prospective observational study with 75 patients in an ICU of a tertiary-care hospital to create a diagnostic model for AGI. We recorded their bowel sounds, assessed AGI grading, collected clinical data, and measured biomarkers. We evaluated the model using misjudgment probability and leave-one-out cross-validation.

RESULTS

Mean bowel sound rate and citrulline level are independent risk factors for AGI. Gastrin was identified as a risk factor for the severity of AGI. Other factors that correlated with AGI include mean bowel sound rate, amplitude, interval time, Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Evaluation II score, platelet count, total protein level, blood gas potential of hydrogen (pH), and bicarbonate (HCO3-) level. Two discriminant models were constructed with a misclassification probability of < 0.1. Leave-one-out cross-validation correctly classified 69.8% of the cases.

CONCLUSION

Our AGI diagnostic model represents a potentially effective approach for clinical AGI grading and holds promise as an objective diagnostic standard for AGI.

Keywords: Critical illness; Acute gastrointestinal injury; Bowel sounds; Biomarker; Intensive care unit; Citrulline; Gastrin; Diagnostic value

Core Tip: We developed a model to discriminate acute gastrointestinal injury (AGI) by continuous monitoring of bowel sounds and biomarker indicators. The study found that mean bowel sound rate and citrulline level are independent risk factors for AGI. Gastrin was identified as a risk factor for the severity of AGI. Two discriminant models were constructed with a misclassification probability of < 0.1. Our AGI diagnostic model represents a potentially effective approach for clinical AGI grading and holds promise as an objective diagnostic standard for AGI.