Comparing gastrointestinal dysfunction score and acute gastrointestinal injury grade for predicting short-term mortality in critically ill patients

Abstract

BACKGROUND

The prognosis of critically ill patients is closely linked to their gastrointestinal (GI) function. The acute GI injury (AGI) grading system, established in 2012, is extensively utilized to evaluate GI dysfunction and forecast outcomes in clinical settings. In 2021, the GI dysfunction score (GIDS) was developed, building on the AGI grading system, to enhance the accuracy of GI dysfunction severity assessment, improve prognostic predictions, reduce subjectivity, and increase reproducibility.

AIM

To compare the predictive capabilities of GIDS and the AGI grading system for 28-day mortality in critically ill patients.

METHODS

A retrospective study was conducted at the general intensive care unit (ICU) of a regional university hospital. All data were collected during the first week of ICU admission. The primary outcome was 28-day mortality. Multivariable logistic regression analyzed whether GIDS and AGI grade were independent risk factors for 28-day mortality. The predictive abilities of GIDS and AGI grade were compared using the receiver operating characteristic curve, with DeLong’s test assessing differences between the curves’ areas.

RESULTS

The incidence of AGI in the first week of ICU admission was 92.13%. There were 85 deaths (47.75%) within 28 days of ICU admission. There was no initial 24-hour difference in GIDS between the non-survival and survival groups. Both GIDS (OR 2.01, 95%CI: 1.25-3.24; P = 0.004) and AGI grade (OR 1.94, 95%CI: 1.12-3.38; P = 0.019) were independent predictors of 28-day mortality. No significant difference was found between the predictive accuracy of GIDS and AGI grade for 28-day mortality during the first week of ICU admission (Z = -0.26, P = 0.794).

CONCLUSION

GIDS within the first 24 hours was an unreliable predictor of 28-day mortality. The predictive accuracy for 28-day mortality from both systems during the first week was comparable.

Keywords: Critical illness; Gastrointestinal dysfunction; Acute gastrointestinal injury; Prognostic indicators; Intensive care unit outcomes; Mortality prediction; Risk stratification; Predictive modeling

Core Tip: Gastrointestinal (GI) function plays a crucial role in the prognosis of critically ill patients. The acute GI injury (AGI) grade and GI dysfunction score (GIDS) are valuable tools for assessing the severity of GI dysfunction and predicting mortality in this patient population. Our study revealed that both GIDS and AGI grade during the first week of intensive care unit (ICU) admission independently predicted 28-day mortality. However, GIDS within the first 24 hours did not prove to be a reliable predictor. The ability to predict 28-day mortality based on the maximum values of GIDS and AGI grade during the initial week of ICU admission was comparable.