Acute gastrointestinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock: Retrospective cohort study

Klanovicz, Tamires Mezzomo; Franzosi, Oellen Stuani; Nunes, Diego Silva Leite; Loss, Sérgio Henrique; Batassini, Érica; Turra, Eduardo Eggers; Teixeira, Cassiano; Vieira, Sílvia Regina Rios

doi:10.1002/ncp.10928

Cited by 3 publications

(3 citation statements)

References 24 publications

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“…Our results are consistent with previously published results by Sun et al, which showed that higher scores of AGI were associated with worse clinical variables, higher rates of septic shock, and higher 28 day mortality in a cohort of critically ill COVID-19 patients [47]. The relationship between AGI score and ICU outcome was studied by Klanovicz et al [52], who found that AGI III present within the first 48 h after ICU admission was a significant risk factor for ICU mortality in patients with septic shock undergoing mechanical ventilation. In septic and septic shock patients, AGI score on admission turns out to be a good 28 day survival predictive tool.…”

Section: Discussionsupporting

confidence: 93%

Citrulline, Intestinal Fatty Acid-Binding Protein and the Acute Gastrointestinal Injury Score as Predictors of Gastrointestinal Failure in Patients with Sepsis and Septic Shock

et al. 2023

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Gastrointestinal (GI) failure can be both a cause of sepsis and a consequence of the systemic pro-inflammatory response in sepsis. Changes in biomarkers of enterocyte damage, citrulline and I-FABP (intestinal fatty acid binding protein), may indicate altered intestinal permeability and damage. The study group consisted of patients with sepsis (N = 28) and septic shock (N = 30); the control group included patients without infection (N = 10). Blood samples were collected for citrulline and I-FABP and a 4-point AGI score (acute GI injury score) was calculated to monitor GI function on days 1, 3, 5, 7, and 10. Citrulline concentrations in the study group were lower than in the control. Lower values were also noted in septic patients with shock when compared to the non-shock group throughout the study period. I-FABP was higher in the septic shock group than in the sepsis group only on days 1 and 3. Citrulline was lower in patients with GI failure (AGI III) when compared to AGI I/II, reaching significance on days 7 (p = 0.034) and 10 (p = 0.015); moreover, a higher AGI score was associated with an increased 28 day mortality (p = 0.038). The results indicate that citrulline measurements, along with the AGI assessment, have clinical potential in monitoring GI function and integrity in sepsis.

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Section: Discussionsupporting

confidence: 93%

Citrulline, Intestinal Fatty Acid-Binding Protein and the Acute Gastrointestinal Injury Score as Predictors of Gastrointestinal Failure in Patients with Sepsis and Septic Shock

et al. 2023

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“…On the contrary, introducing luminal nutrients into critically ill patients with septic shock (receiving vasopressor) increases the risk of EFI and gastrointestinal dysfunction. Klanovicz et al [23] applied the European Society of Intensive Care Medicine's acute gastrointestinal injury (AGI) criteria to 163 mechanically ventilated patients with septic shock and found AGI was frequent during the first week of ICU admission. AGI risk/dysfunction was found in 87% and AGI failure in 12% and higher heart rate and lower mean arterial pressure were identified in patients with AGI failure [23].…”

Section: The Conundrum Of Introducing Luminal Nutrients In Septic Shockmentioning

confidence: 99%

“…Klanovicz et al [23] applied the European Society of Intensive Care Medicine's acute gastrointestinal injury (AGI) criteria to 163 mechanically ventilated patients with septic shock and found AGI was frequent during the first week of ICU admission. AGI risk/dysfunction was found in 87% and AGI failure in 12% and higher heart rate and lower mean arterial pressure were identified in patients with AGI failure [23]. In an analysis of more than 15 000 patients from an International Nutrition Survey, Heyland et al [24 & ] found that sepsis is associated with EFI (OR 1.34; 95% CI 1.17-1.54) and the daily mortality hazard ratio increased by a factor of 1.5 (95% CI 1.4-1.6; P < 0.0001) once EFI occurred.…”

Section: The Conundrum Of Introducing Luminal Nutrients In Septic Shockmentioning

confidence: 99%

Enteral nutrition in septic shock: a call for a paradigm shift

Patel,

Lopez-Delgado,

Stoppe

et al. 2024

Current Opinion in Critical Care

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Purpose of review The purpose of this review is to identify contemporary evidence evaluating enteral nutrition in patients with septic shock, outline risk factors for enteral feeding intolerance (EFI), describe the conundrum of initiating enteral nutrition in patients with septic shock, appraise current EFI definitions, and identify bedside monitors for guiding enteral nutrition therapy. Recent findings The NUTRIREA-2 and NUTRIREA-3 trial results have better informed the dose of enteral nutrition in critically ill patients with circulatory shock. In both trials, patients with predominant septic shock randomized to receive early standard-dose nutrition had more gastrointestinal complications. Compared to other contemporary RCTs that included patients with circulatory shock, patients in the NUTRIREA-2 and NUTRIREA-3 trials had higher bowel ischemia rates, were sicker, and received full-dose enteral nutrition while receiving high baseline dose of vasopressor. These findings suggest severity of illness, vasopressor dose, and enteral nutrition dose impact outcomes. Summary The provision of early enteral nutrition preserves gut barrier functions; however, these benefits are counterbalanced by potential complications of introducing luminal nutrients into a hypo-perfused gut, including bowel ischemia. Findings from the NUTRIREA2 and NUTRIREA-3 trials substantiate a ‘less is more’ enteral nutrition dose strategy during the early acute phase of critical illness. In the absence of bedside tools to guide the initiation and advancement of enteral nutrition in patients with septic shock, the benefit of introducing enteral nutrition on preserving gut barrier function must be weighed against the risk of harm by considering dose of vasopressor, dose of enteral nutrition, and severity of illness.

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

Shen,

Wang,

Xiao

et al. 2024

World J Gastroenterol

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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.

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Acute gastrointestinal failure is associated with worse hemodynamic and perfusion parameters over 48 h after admission in patients with septic shock: Retrospective cohort study

Cited by 3 publications

References 24 publications

Citrulline, Intestinal Fatty Acid-Binding Protein and the Acute Gastrointestinal Injury Score as Predictors of Gastrointestinal Failure in Patients with Sepsis and Septic Shock

Citrulline, Intestinal Fatty Acid-Binding Protein and the Acute Gastrointestinal Injury Score as Predictors of Gastrointestinal Failure in Patients with Sepsis and Septic Shock

Enteral nutrition in septic shock: a call for a paradigm shift

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

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