Risk factors of critically ill patients with gastrointestinal dysfunction and effects on prognosis
10.3969/j.issn.1008-9691.2019.05.014
- VernacularTitle:影响危重症患者胃肠功能障碍的危险因素分析
- Author:
Junxiu MA
1
;
Zhenwei LI
;
Jiawei JIANG
;
Wei CAO
;
Linghua FAN
Author Information
1. 天津市静海区医院重症医学科
- Keywords:
Critical illness;
Gastrointestinal dysfunction;
Risk factors;
Prognosis
- From:
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2019;26(5):569-572
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the risk factors of gastrointestinal dysfunction in critically ill patients and provide reference for the prevention and treatment of gastrointestinal dysfunction. Methods A retrospective study was conducted, and the data of patients admitted to intensive care unit (ICU) of Jinghai District Hospital from September 2018 to March 2019 were collected. The data including sex, age, sequential organ failure score (SOFA), acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ), diagnosis in ICU, application of special drugs, hemoglobin (Hb), blood glucose, albumin (Alb) levels and presence or absence of bacteremia were collected. The patients were divided into gastrointestinal dysfunction group and non-gastrointestinal dysfunction group according to whether gastrointestinal dysfunction occurred or not. The general data, related final outcome and prognosis were compared between the two groups. Logistic regression analysis was used to analyze the risk factors affecting gastrointestinal dysfunction in critical ill patients, and the possible existing complications were recorded. The receiver operating characteristic curve (ROC) was drawn to evaluate the predictive values of risk factors. Results One hundred and thirty-eight patients were enrolled in this study, and 86 patients had gastrointestinal dysfunction. The SOFA score and proportions of using catecholamine and bacteremia in the gastrointestinal dysfunction group were significantly higher than those in the non-gastrointestinal dysfunction group [SOFA score: 7.2±3.8 vs. 5.8±3.6, the proportion of using catecholamine: 57.0% (49/86) vs. 38.5% (20/52), the proportion of bacteremia: 32.6%(28/86) vs.17.3%(9/52), all P < 0.05], Alb level was significantly lower than that in the non-gastrointestinal dysfunction group (g/L: 24.15±5.75 vs. 26.55±5.68, P < 0.05). Logistic regression analysis showed that the use of catecholamine, Alb level, bacteremia and SOFA score in ICU were the risk factors for occurrence of gastrointestinal dysfunction in ICU patients [odd ratios (OR) were 1.128, 0.547, 1.645, 1.958, 95% confidence intervals (95% CI) were 1.052-1.219, 0.384-0.765, 1.143-2.597, 1.925-1.993, P values were 0.011, 0.017, 0.021, 0.016, respectively]. Compared with the non-gastrointestinal dysfunction group, the incidence of bedsore, the proportion of energy intake unable to reach the target, the length of stay in ICU and the mortality in gastrointestinal dysfunction group were significantly increased [the incidence of bedsore: 53.5% (46/86) vs. 30.8% (16/52), the proportion of intake unable to reach the target: 27.9% (24/86) vs. 5.8% (3/52), the length of stay in ICU (days): 22.5±17.8 vs. 16.0±11.5, mortality rate: 51.2% (44/86) vs. 34.6% (18/52), all P < 0.05]. ROC curve analysis showed that the use of catecholamine, bacteremia present or not, Alb level and SOFA score showed certain extents of predictive values for the occurrence of gastrointestinal dysfunction in critically ill patients the area under ROC curve (AUC) were 0.794, 0.712, 0.705 and 0.882, respectively, 95% confidence interval (95% CI) were 0.708-0.880, 0.609-0.816, 0.579-0.830, 0.801-0.962, sensitivity were 58.8%, 42.5%, 76.3%, 75.0%, specificity were 100%, 60%, 100%, 85%, all P < 0.05. Conclusions The use of catecholamine, Alb level, bacteremia and high SOFA score are the risk factors of gastrointestinal dysfunction in critically ill patients. Prevention of gastrointestinal motility disorder can improve the treatment success rate of critical patients.
