Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2020; 26(5): 514-523
Published online Feb 7, 2020. doi: 10.3748/wjg.v26.i5.514
Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis
Ling Ding, Hong-Yan Chen, Jin-Yun Wang, Hui-Fang Xiong, Wen-Hua He, Liang Xia, Nong-Hua Lu, Yin Zhu
Ling Ding, Hong-Yan Chen, Jin-Yun Wang, Hui-Fang Xiong, Wen-Hua He, Liang Xia, Nong-Hua Lu, Yin Zhu, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
Author contributions: Ding L and Chen HY designed the study, collected the data, and wrote the manuscript; Wang JY helped in collecting the data; Xiong HF conceived of the study and participated in its design; He WH and Xia L helped in analyzing the data; Lu NH and Zhu Y made substantial contributions to conception, design, and coordination of the study and gave final approval of the version to be published; all authors read and approved the final manuscript.
Supported by the National Natural Science Foundation of China, No. 81760120.
Institutional review board statement: This study was approved by the Ethics Committee of the First Affiliated Hospital of Nanchang University.
Informed consent statement: All involved subjects gave their informed consent (written or verbal) prior to study inclusion.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
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: Yin Zhu, PhD, Chief Doctor, Professor of Medicine, Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, 17 Yongwaizheng Street, Nanchang 330006, Jiangxi Province, China. zhuyin27@sina.com
Received: December 3, 2019
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
Abstract
BACKGROUND

Gastrointestinal (GI) dysfunction is a common and important complication of acute pancreatitis (AP), especially in patients with severe AP. Despite this, there is no consensus means of obtaining a precise assessment of GI function.

AIM

To determine the association between acute gastrointestinal injury (AGI) grade and clinical outcomes in critically ill patients with AP.

METHODS

Patients with AP admitted to our pancreatic intensive care unit from May 2017 to May 2019 were enrolled. GI function was assessed according to the AGI grade proposed by the European Society of Intensive Care Medicine in 2012, which is mainly based on GI symptoms, intra-abdominal pressure, and feeding intolerance in the first week of admission to the intensive care unit. Multivariate logistic regression analysis was performed to assess the association between AGI grade and clinical outcomes in critically ill patients with AP.

RESULTS

Among the 286 patients included, 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. The distribution of mortality was 0% among those with grade I, 6.35% among those with grade II, 30.11% among those with grade III, and 61.29% among those with grade IV, and AGI grade was positively correlated with mortality (χ2 = 31.511, P < 0.0001). Multivariate logistic regression analysis showed that age, serum calcium level, AGI grade, persistent renal failure, and persistent circulatory failure were independently associated with mortality. Compared with the Acute Physiology and Chronic Health Evaluation II score (area under the curve: 0.739 vs 0.854; P < 0.05) and Ranson score (area under the curve: 0.72 vs 0.854; P < 0.01), the AGI grade was more useful for predicting mortality.

CONCLUSION

AGI grade is useful for identifying the severity of GI dysfunction and can be used as a predictor of mortality in critically ill patients with AP.

Keywords: Acute pancreatitis, Gastrointestinal dysfunction, Acute gastrointestinal injury, Mortality, Predictive factor, Critically ill

Core tip: Gastrointestinal (GI) dysfunction is a common and important complication of acute pancreatitis, especially in patients with severe acute pancreatitis. Despite this, no consensus has been reached on a more precise assessment of GI function. In this manuscript, we studied the feasibility of using the acute GI injury grade to evaluate GI function, and concluded that the acute GI injury grade is helpful to identify the severity of GI dysfunction and can be used as a predictor of mortality in patients with acute pancreatitis.