Acute Gastrointestinal Injury in Critically Ill Patients in a South Indian Intensive Care Unit: A Prospective, Observational, Preliminary Study

Abstract

Objective: Determine the prognostic implication of gastrointestinal injury in critically ill patients. Determine the factors predisposing to development of acute gastrointestinal injury. Material(s) and Method(s): A prospective, observational, single center study was conducted on critically ill patients (APACHE > 8) on enteral tube feeds, admitted in a mixed ICU of a tertiary care hospital. Patients with terminal diseases which limited aggressive therapy, pregnant or mentally challenged patients were excluded. Anthropometric data, admission diagnosis, APACHE II score, and comorbidities were recorded. Data of daily heart rate, mean arterial pressure, dose of vasopressors, intra-abdominal pressure, fluid balance, feeding intolerance, mechanical ventilation, laboratory tests were noted for first 7 days of ICU stay or till ICU discharge. Outcome at ICU discharge and at 28 days were recorded. Acute gastrointestinal injury (AGI) grade (I-IV) was the outcome of interest. Factors identified as significant were entered into a regression model with AGI grade and outcome at 28 days as ordinal and categorical dependent variables, respectively. Result(s): Data was collected from 33 patients over 190 patient days. A positive fluid balance and higher AGI scores were significantly associated with increased mortality at 28 days with p values of <0.0009 and 0.001, respectively. APACHE II, fluid balance, creatinine and lactate were entered into an ordinal logistic regression model, and fluid balance was found to have a significant correlation with acute GI injury with p value of 0.023. However, when fitted into a predictive model, they were found to be noncontributory. Conclusion(s): Higher AGI scores were associated with mortality in critically ill patients. Acute GI injury was associated with higher fluid balance. However, none of these were found to be predictors of mortality.