Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis

Table 1 Characteristics of the patients stratified by global acute gastrointestinal injury grade, n (%)

Characteristic	AGI grade I (n = 99)	AGI grade II (n = 63)	AGI grade III (n = 93)	AGI grade IV (n = 31)	P value
Male	61 (61.62)	29 (46.03)	67 (72.04)	24 (77.42)	0.003
Age, yr	49 (40,65)	49 (36,64)	48 (40,64)	51 (39,62)	0.995
BMI, kg/m2	24.34 (21.69, 26.42)	23.97 (20.78, 27.43)	24.63 (22.68, 27.7)	25.23 (22.4, 28.54)	0.251
Etiology					0.037
Biliary	38 (38.38)	31 (49.21)	37 (39.78)	7 (22.58)
Alcoholic	9 (9.09)	4 (6.35)	15 (16.13)	9 (29.03)
Hyperlipidemic	45 (45.45)	25 (39.68)	39 (41.94)	12 (38.71)
Others	7 (7.07)	3 (4.76)	2(2.15)	3 (9.68)
History of tobacco use	28 (28.28)	19 (30.16)	25 (26.88)	13 (41.94)	0.444
History of alcohol use	28 (28.28)	12 (19.05)	35 (37.63)	16 (51.61)	0.006
Diabetes mellitus	17 (17.17)	10 (15.87)	11 (11.83)	9 (29.03)	0.167
Hypertension	18 (18.18)	13 (20.63)	19 (20.43)	8 (25.81)	0.836
1C-reactive protein, mg/L	138 (91.7, 268.5)	266 (149, 384)	318 (225, 399)	276.5 (240, 386.5)	< 0.001
1Procalcitonin, ng/mL	0.94 (0.26, 2.84)	1.05 (0.37, 3.44)	7.59 (2.11, 23.44)	7.8 (1.18, 20.87)	< 0.001
1Urea nitrogen, mmol/L	5.7 (4.3, 7.5)	7.5 (4.5, 9.4)	10.5 (7.3, 16)	12.3 (8.2, 16.8)	< 0.001
1Calcium, mmol/L	2.12 (2.02, 2.26)	1.99 (1.88, 2.18)	1.87 (1.68, 2.13)	1.77 (1.62, 1.92)	< 0.001
1D-dimer, mg/L FEU	2.42 (1.23, 4.33)	3.30 (2.02, 5.33)	4.9 (2.84, 8.88)	4.23 (2.4, 7.51)	< 0.001
1Glucose, mmol/L	8.54 (5.91, 11.07)	8.3 (6.93, 11.5)	8.49 (7.05,11.78)	7.79 (6.5, 10.55)	0.737
1Albumin, g/L	34.8 (32.4, 39.3)	33.6 (30.8, 36.6)	32.75 (30.45, 35.1)	33 (28.7, 34.6)	< 0.001
IPN	4 (4.04)	7 (11.11)	26 (27.96)	15 (48.39)	< 0.001
2Extrapancreatic infection	3 (3.03)	10 (15.87)	31 (33.33)	18 (58.06)	< 0.001
3Persistent OF	13 (13.13)	35 (55.56)	69 (74.19)	30 (96.77)	< 0.001
4Persistent multiple OF	1 (1.01)	6 (9.52)	32 (34.41)	25 (80.65)	< 0.001
Length of hospital stay, d	10 (8,14)	15 (9,23)	20 (12,33.5)	23 (9,51)	< 0.001
Length of ICU stay, d	3 (2,5)	7 (4,10)	11 (6,17.5)	19 (9,32)	< 0.001
Death	0 (0)	4 (6.35)	28 (30.11)	19 (61.29)	< 0.001

¹The laboratory indictors were tested using serum samples obtained within the first 24 h of ICU admission;

²Extrapancreatic infection included septicemia, pulmonary infection, urinary infection, or other extrapancreatic infections diagnosed by positive culture;

³Persistent organ failure (>48 h) included respiratory failure, circulatory failure, or renal failure;

⁴Persistent multiple organ failure included ≥2 failing organ systems, including respiratory, circulatory, and renal systems. AGI: Acute gastrointestinal injury; BMI: Body mass index; IPN: Infected pancreatic necrosis; OF: Organ failure.

Table 2 Factors associated with mortality according to univariate logistic regression analysis

Variable	B	OR (95%CI)	P value
Male sex	0.075	1.078 (0.573-2.028)	0.817
Age	0.043	1.044 (1.024-1.064)	< 0.001
BMI	-0.020	0.980 (0.913-1.052)	0.574
Etiology of AP
Biliary	Ref	Ref	Ref
Alcoholic	0.630	1.878 (0.822-4.293)	0.135
Hyperlipidemic	-0.669	0.512 (0.249-1.053)	0.069
Others	-0.507	0.602 (0.127-2.858)	0.523
History of tobacco use	-0.256	0.774 (0.389-1.541)	0.467
History of alcohol use	0.723	2.060 (1.108-3.829)	0.022
Diabetes mellitus	-0.067	0.935 (0.408-2.143)	0.874
Hypertension	0.496	1.643 (0.818-3.297)	0.163
Urea nitrogen	0.190	1.209 (1.140-1.283)	< 0.001
Calcium	-2.444	0.087 (0.029-0.263)	< 0.001
D-dimer	0.090	1.094 (1.045-1.146)	< 0.001
Glucose	-0.014	0.986 (0.924-1.053)	0.671
Albumin	-0.088	0.916 (0.850-0.986)	0.020
Global AGI grade (I/II vs III/IV)	3.183	24.110 (8.382-69.352)	< 0.001
Persistent respiratory failure	2.834	17.013 (5.933-48.785)	< 0.001
Persistent renal failure	2.489	12.048 (5.634-25.764)	< 0.001
Persistent circulatory failure	3.731	41.719 (18.402-94.584)	< 0.001

OR: Odds ratio; CI: Confidence interval; BMI: Body mass index; AP: Acute pancreatitis; AGI: Acute gastrointestinal injury.

Table 3 Factors associated with mortality according to multivariate logistic regression analysis

Variables	B	OR (95%CI)	P value
Age	0.092	1.096 (1.055-1.139)	< 0.001
Calcium	-2.147	0.117 (0.015-0.901)	0.039
Global AGI grade (I/II vs III/IV)	1.249	3.487 (1.685-7.214)	0.001
Persistent renal failure	1.513	4.538 (1.347-15.292)	0.015
Persistent circulatory failure	3.184	24.148 (7.919-73.638)	< 0.001

OR: Odds ratio; CI: Confidence interval; AGI: Acute gastrointestinal injury.

Table 4 Accuracy of each score for predicting mortality according to receiver operating characteristic curve analysis

Variables	Sensitivity	specificity	AUC (95%CI)	Cutoff value
AGI grade	91.67%	67.13%	0.854 (0.806-0.895)	> grade II
APACHEII score	68.75%	70.83%	0.739 (0.682-0.791)	> 12
Modified Marshall score	64.58%	83.33%	0.785 (0.730-0.833)	> 2
Ranson score	54.17%	81.94%	0.720 (0.662-0.774)	> 4

AUC: Area under the curve; CI: Confidence interval; AGI: Acute gastrointestinal injury; APACHE: Acute Physiology and Chronic Health Evaluation.