Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study.
Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study.
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DOI：
10.1007/s00134-013-2831-1
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发表时间：
2013-05
影响因子：
38.9
通讯作者：
Starkopf, Joel
中科院分区：
文献类型：
--
作者：
Blaser, Annika Reintam;Poeze, Martijn;Malbrain, Manu L. N. G.;Bjorck, Martin;Oudemans-van Straaten, Heleen M.;Starkopf, Joel
该研究旨在开发胃肠（GI）功能障碍评分，预测需要机械通气（MV）的成年患者28天死亡率。前瞻性研究了来自40个icu的377名成年患者，预期MV持续时间至少为6小时。在第1、2、4和7天记录预定的胃肠道症状、腹内压（IAP）、喂养细节、器官功能障碍和治疗情况。非幸存者每天同时出现胃肠道症状的数量较高。无肠音和消化道出血是与死亡率最显著相关的症状。单独的胃肠道症状都不是死亡率的独立预测因子，但胃肠道衰竭(GIF) -定义为三种或更多的胃肠道症状-在ICU的第一天与死亡风险增加三倍独立相关。在ICU的第一周，24名患者（6.4%）发生GIF，并与较高的28天死亡率相关（62.5% vs 28.9%, P = 0.001）。将创建的胃肠道功能障碍亚评分（基于胃肠道症状的数量）添加到SOFA评分中并不能改善死亡率预测（第1天的AUROC为0.706 [95% CI 0.647-0.766]，而单独的SOFA评分为0.703 [95% CI 0.643-0.762]）。越来越多的胃肠道症状独立预测28天死亡率，准确度中等。然而，由于数据集的限制、定义问题，或者可能表明GI功能障碍通常是继发性的，而不是其他器官衰竭的主要原因，因此不可能制定GI功能障碍评分，从而提高SOFA评分的性能。
The study aimed to develop a gastrointestinal (GI) dysfunction score predicting 28-day mortality for adult patients needing mechanical ventilation (MV). 377 adult patients from 40 ICUs with expected duration of MV for at least 6 h were prospectively studied. Predefined GI symptoms, intra-abdominal pressures (IAP), feeding details, organ dysfunction and treatment were documented on days 1, 2, 4 and 7. The number of simultaneous GI symptoms was higher in nonsurvivors on each day. Absent bowel sounds and GI bleeding were the symptoms most significantly associated with mortality. None of the GI symptoms alone was an independent predictor of mortality, but gastrointestinal failure (GIF)—defined as three or more GI symptoms—on day 1 in ICU was independently associated with a threefold increased risk of mortality. During the first week in ICU, GIF occurred in 24 patients (6.4 %) and was associated with higher 28-day mortality (62.5 vs. 28.9 %, P = 0.001). Adding the created subscore for GI dysfunction (based on the number of GI symptoms) to SOFA score did not improve mortality prediction (day 1 AUROC 0.706 [95 % CI 0.647–0.766] versus 0.703 [95 % CI 0.643–0.762] in SOFA score alone). An increasing number of GI symptoms independently predicts 28 day mortality with moderate accuracy. However, it was not possible to develop a GI dysfunction score, improving the performance of the SOFA score either due to data set limitations, definition problems, or possibly indicating that GI dysfunction is often secondary and not the primary cause of other organ failure.
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影响因子：
2.1
作者：
Reintam, A.;Parm, P.;Starkopf, J.
通讯作者：
Starkopf, J.
影响因子：
8.8
作者：
Mentec, H;Dupont, H;Bleichner, G
通讯作者：
Bleichner, G
影响因子：
8.8
作者：
Montejo, JC
通讯作者：
Montejo, JC
影响因子：
38.9
作者：
Dalfino, Lidia;Tullo, Livio;Brienza, Nicola
通讯作者：
Brienza, Nicola
影响因子：
38.9
作者：
Blaser, Annika Reintam;Malbrain, Manu L. N. G.;Starkopf, Joel;Fruhwald, Sonja;Jakob, Stephan M.;De Waele, Jan;Braun, Jan-Peter;Poeze, Martijn;Spies, Claudia
通讯作者：
Spies, Claudia