Evaluation of clinical application of ESICM acute gastrointestinal injury grading system: a single-center observational study / 中华医学杂志(英文版)

ABSTRACT

<p><b>BACKGROUND</b>In 2012, the working group on abdominal problems of the European Society of Intensive Care Medicine (ESICM) proposed a definition and also guidelines for the grading system and treatment of acute gastrointestinal injury (AGI). Until now, clinical reports on this topic have not been available, and the practicality of using the AGI grading system requires further validation in the clinic. Therefore, we conducted this study to evaluate the feasibility of utilizing the current AGI grading system in a clinical environment, and to provide evidence for its usefulness in assessing the severity and prognosis of critically ill patients with gastrointestinal dysfunction.</p><p><b>METHODS</b>A total of 133 patients were examined for the presence or absence of AGI, their scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II and Lausanne Intestinal Failure Estimation (LIFE) test, and 28 days mortality. The presence and severity of AGI was based on guidelines provided by the ESICM. The patients were assigned to a NO-AGI group (n = 50) or an AGI group (n = 83). The AGI group was then further divided into three subgroups, consisting of AGI I (risk group, n = 38), AGI II (gastrointestinal dysfunction group, n = 33) and AGI III+AGI IV (gastrointestinal failure group, n = 12). These subgroups were then compared for differences in AGI indicators.</p><p><b>RESULTS</b>There were no statistically significant differences between the AGI group and the NO-AGI group in terms of age, gender, APACHE II score or LIFE score (P > 0.05); however, the two groups showed a significant difference in their respective rates of 28 days mortality (32.5% in the AGI group vs. 8.0% in the NO-AGI group (P < 0.05)). Patients in the three AGI subgroups showed significant differences in their 28 d mortality rates, APACHE II, and LIFE scores. AGI grading system showed strong positive correlations with APACHE II and LIFE scores (P < 0.05).</p><p><b>CONCLUSIONS</b>The current AGI grading system can be used to identify and evaluate gastrointestinal dysfunction in critically ill patients, and also to provide a preliminary assessment regarding the prognosis for patients with different grades of AGI.</p>