Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis
Severity of acute gastrointestinal injury grade is a good predictor of mortality in critically ill patients with acute pancreatitis
复制标题
急性胃肠道损伤的严重程度是急性胰腺炎危重患者死亡率的良好预测指标
DOI：
10.3748/wjg.v26.i5.514
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发表时间：
2020-02-07
影响因子：
4.3
通讯作者：
Zhu, Yin
中科院分区：
文献类型：
--
作者：
Ding, Ling;Chen, Hong-Yan;Zhu, Yin
胃肠道功能障碍是急性胰腺炎（AP）常见且重要的并发症，尤其是在严重AP患者中。尽管如此，对胃肠道功能的精确评估尚无一致的方法。目的探讨急性胃肠损伤（AGI）分级与重症AP患者临床结局的关系。方法纳入2017年5月至2019年5月在我院胰腺重症监护病房住院的AP患者。GI功能评估依据2012年欧洲重症医学会（European Society of Intensive Care Medicine）提出的AGI分级，主要依据重症监护病房入院第一周的GI症状、腹内压、进食不耐受等指标。结果纳入的286例AP危重患者中，AGI分级分别为I级34.62%，II级22.03%，III级32.52%，IV级10.84%，I级死亡率为0%，II级死亡率为6.35%，III级死亡率为30.11%。ⅳ级为61.29%，AGI分级与死亡率呈正相关（χ2 = 31.511, P < 0.0001）。多因素logistic回归分析显示，年龄、血钙水平、AGI分级、持续性肾功能衰竭和持续性循环衰竭与死亡率独立相关。与急性生理与慢性健康评估II评分（曲线下面积：0.739 vs 0.854, P < 0.05）和Ranson评分（曲线下面积：0.72 vs 0.854, P < 0.01）相比，AGI评分对预测死亡率更有用。结论AGI分级可用于判断AP危重患者的GI功能障碍严重程度，并可作为预测患者死亡率的指标。
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.