Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients – A prospective multicenter observational study (iSOFA study)

Blaser, Annika Reintam; Padar, Martin; Mändul, Merli; Elke, Gunnar; Engel, Christoph; Fischer, Krista; Giabicani, Mikhaël; Gold, T.; Hess, Benjamin; Hiesmayr, Michael; Jakob, Stephan M.; Loudet, Cecilia; Meesters, Dennis M.; Mongkolpun, Wasineenart; Paugam–Burtz, Catherine; Poeze, Martijn; Preiser, Jean-Charles; Renberg, Mattias; Rooijackers, O.; Tamme, Kadri; Wernerman, Jan; Starkopf, Joel

doi:10.1016/j.clnu.2021.07.015

Cited by 72 publications

(79 citation statements)

References 21 publications

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“…Recently, Bachmann et al found that there are few patients with 2 cardiovascular SOFA points, and the prognostic value of cardiovascular SOFA was poor in patients assessed for intra‐abdominal hypertension and gastrointestinal dysfunction 23‐25 . Our findings in a large sample of general ICU patients confirm this.…”

Section: Discussionsupporting

confidence: 82%

Association of Sequential Organ Failure Assessment (SOFA) components with mortality

Pölkki

Pekkarinen

Takala

et al. 2022

Acta Anaesthesiol Scand

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Background: Sequential Organ Failure Assessment (SOFA) is a practical method to describe and quantify the presence and severity of organ system dysfunctions and failures. Some proposals suggest that SOFA could be employed as an endpoint in trials. To justify this, all SOFA component scores should reflect organ dysfunctions of comparable severity. We aimed to investigate whether the associations of different SOFA components with in-hospital mortality are comparable. Methods:We performed a study based on nationwide register data on adult patients admitted to 26 Finnish intensive care units (ICUs) during 2012−2015. We determined the SOFA score as the maximum score in the first 24 hours after ICU admission. We defined organ failure (OF) as an organ-specific SOFA score of three or higher. We evaluated the association of different SOFA component scores with mortality. Results:Our study population comprised 63,756 ICU patients. Overall hospital mortality was 10.7%. In-hospital mortality was 22.5% for patients with respiratory failure, 34.8% for those with coagulation failure, 40.1% for those with hepatic failure, 14.9% for those with cardiovascular failure, 26.9% for those with neurologic failure and 34.6% for the patients with renal failure. Among patients with comparable total SOFA scores, the risk of death was lower in patients with cardiovascular OF compared with patients with other OFs. Conclusions:All SOFA components are associated with mortality, but their weights are not comparable. High scores of other organ systems mean a higher risk of death than high cardiovascular scores. The scoring of cardiovascular dysfunction needs to be updated.

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Section: Discussionsupporting

confidence: 82%

Association of Sequential Organ Failure Assessment (SOFA) components with mortality

Pölkki

Pekkarinen

Takala

et al. 2022

Acta Anaesthesiol Scand

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“…Monitoring and management of EFI and GI dysfunction is complicated due to the lack of robust and reproducible markers and multifaceted clinical presentation [ 49 ]. As no single straightforward marker reliably detects GI dysfunction, using composite scores combining several symptoms and signs could be helpful and should be considered [ 131 ]. EFI at the bedside is defined as features of GI dysfunction appearing during EN and consequently leading to reduction or discontinuation of EN.…”

Section: Question 10: How To Assess Gastrointestinal Intolerance?mentioning

confidence: 99%

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Preiser

Arabi

Berger³

et al. 2021

Crit Care

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The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

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“…In addition to TBSA, GI dysfunction was also associated with sepsis (Spearman’s r = 0.237, P < 0.001) (Table 6 , Additional file 2 : Table S2), but sepsis was not an independent risk factor for GI dysfunction in the multiple logistic regression analysis. The iSOFA study indicated that the Gastrointestinal Dysfunction Score (GIDS) combined with the SOFA score could better predict 28-day and 90-day mortality of critically ill patients than using a single SOFA score [ 42 ]. We found similar results, where the retrospectively scored GI dysfunction of our patients before or within 1 month after injury were strongly correlated with all-cause 90-day mortality, both in univariate and multivariate analyses ( P < 0.001, Additional file 2 : Table S3).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, repeated and massive GI haemorrhages further increase the risk of blood volume loss and even aspiration, which will cause secondary injury to severe burns and increase the risk of death. Recent GI dysfunction papers [ 42 , 45 ] have shown that GI bleeding is higher-level evidence of GI injury in critically ill patients, which strongly suggests GI failure.…”

Section: Discussionmentioning

confidence: 99%

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

Qin

et al. 2022

Military Med Res

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Background Data on severe and extensive burns in China are limited, as is data on the prevalence of a range of related gastrointestinal (GI) disorders [such as stress ulcers, delayed defecation, opioid-related bowel immotility, and abdominal compartment syndrome (ACS)]. We present a multicentre analysis of coincident GI dysfunction and its effect on burn-related mortality. Methods This retrospective analysis was conducted on patients with severe [≥ 20% total burn surface area (TBSA)] and extensive (> 50% TBSA or > 25% full-thickness TBSA) burns admitted to three university teaching institutions in China between January 1, 2011 and December 31, 2020. Both 30- and 90-day mortality were assessed by collating demographic data, burn causes, admission TBSA, % full-thickness TBSA, Baux score, Abbreviated Burn Severity Index (ABSI) score, and Sequential Organ Failure Assessment (SOFA) score, shock at admission and the presence of an inhalation injury. GI dysfunction included abdominal distension, nausea/vomiting, diarrhoea/constipation, GI ulcer/haemorrhage, paralytic ileus, feeding intolerance and ACS. Surgeries, length of intensive care unit (ICU) stay, pain control [in morphine milligram equivalents (MME)] and overall length of hospital stay (LOHS) were recorded. Results We analyzed 328 patients [75.6% male, mean age: (41.6 ± 13.6) years] with a median TBSA of 62.0% (41.0–80.0%); 256 (78.0%) patients presented with extensive burns. The 90-day mortality was 23.2% (76/328), with 64 (84.2%) of these deaths occurring within 30 d and 25 (32.9%) occurring within 7 d. GI dysfunction was experienced by 45.4% of patients and had a significant effect on 90-day mortality [odds ratio (OR) = 14.070, 95% confidence interval (CI) 5.886–38.290, P < 0.001]. Multivariate analysis showed that GI dysfunction was associated with admission SOFA score and % full-thickness TBSA. Overall, 88.2% (67/76) of deceased patients had GI dysfunction [hazard ratio (HR) for death of GI dysfunction = 5.951], with a survival advantage for functional disorders (diarrhoea, constipation, or nausea/vomiting) over GI ulcer/haemorrhage (P < 0.001). Conclusion Patients with severe burns have an unfavourable prognosis, as nearly one-fifth died within 90 d. Half of our patients had comorbidities related to GI dysfunction, among which GI ulcers and haemorrhages were independently correlated with 90-day mortality. More attention should be given to severe burn patients with GI dysfunction.

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Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients – A prospective multicenter observational study (iSOFA study)

Cited by 72 publications

References 21 publications

Association of Sequential Organ Failure Assessment (SOFA) components with mortality

Association of Sequential Organ Failure Assessment (SOFA) components with mortality

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Gastrointestinal dysfunction is associated with mortality in severe burn patients: a 10-year retrospective observational study from South China

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