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©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
Acute gastrointestinal injury in critically ill patients with COVID-19 in Wuhan, China
Jia-Kui Sun, Ying Liu, Lei Zou, Wen-Hao Zhang, Jing-Jing Li, Yu Wang, Xiao-Hua Kan, Jiu-Dong Chen, Qian-Kun Shi, Shou-Tao Yuan
Jia-Kui Sun, Ying Liu, Lei Zou, Wen-Hao Zhang, Yu Wang, Xiao-Hua Kan, Jiu-Dong Chen, Qian-Kun Shi, Shou-Tao Yuan, Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, Jiangsu Province, China
Jia-Kui Sun, Ying Liu, Lei Zou, Wen-Hao Zhang, Jing-Jing Li, Yu Wang, Xiao-Hua Kan, Qian-Kun Shi, Shou-Tao Yuan, Department of Isolation Units, Tongji Hospital, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
Jing-Jing Li, Department of Intensive Care Unit, Lishui People's Hospital, Nanjing 211200, Jiangsu Province, China
Author contributions: Sun JK and Liu Y contributed equally to this study; Sun JK, Shi QK and Yuan ST designed the research; Sun JK, Liu Y, Zou L, Zhang WH, Li JJ, Wang Y, Kan XH and Chen JD performed the research; Sun JK, Liu Y and Zou L analyzed the data; Sun JK and Zou L wrote the paper; Shi QK and Yuan ST are both corresponding authors.
Supported by National Natural Science Foundation of China, No. 81701881; and Nanjing Medical Science and Technology Development Foundation, No. YKK17102.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Nanjing First Hospital and Tongji Hospital. Written informed consent was waived as this was a retrospective study.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: No additional data are available.
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:
http://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Qian-Kun Shi, MD, Doctor, Department of Intensive Care Unit, Nanjing First Hospital, Nanjing Medical University, No. 68 Changle Road, Nanjing 210006, Jiangsu Province, China. njdrsqw2019@163.com
Received: June 2, 2020
Peer-review started: June 2, 2020
First decision: July 29, 2020
Revised: August 6, 2020
Accepted: September 16, 2020
Article in press: September 16, 2020
Published online: October 21, 2020
BACKGROUND
The coronavirus disease 2019 (COVID-19) is spreading rapidly around the world. Most critically ill patients have organ injury, including acute respiratory distress syndrome, acute kidney injury, cardiac injury, or liver dysfunction. However, few studies on acute gastrointestinal injury (AGI) have been reported in critically ill patients with COVID-19.
AIM
To investigate the prevalence and outcomes of AGI in critically ill patients with COVID-19.
METHODS
In this retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-d mortality.
RESULTS
From February 10 to March 10 2020, 83 critically ill patients out of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of these patients, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. Forty (48.2%) patients died within 28 days of admission. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, and septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, a higher incidence of septic shock and 28-d mortality. Sequential organ failure assessment (SOFA) scores (95%CI: 1.374-2.860; P < 0.001), white blood cell (WBC) counts (95%CI: 1.037-1.379; P = 0.014), and duration of mechanical ventilation (MV) (95%CI: 1.020-1.340; P = 0.025) were risk factors for the development of AGI grade II and above.
CONCLUSION
The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had a higher incidence of septic shock and 28-d mortality.
Core Tip: This is the first study to investigate acute gastrointestinal injury (AGI) in critically ill patients with coronavirus disease 2019. The incidence of AGI was 86.7%, and hospital mortality was 48.2% in critically ill patients. Sequential organ failure assessment scores, white blood cell counts, and duration of mechanical ventilation were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had worse clinical severity variables, a higher incidence of septic shock, and higher hospital mortality.
