Acute gastrointestinal injury in critically ill patients with coronavirus disease 2019 in Wuhan, China

AbstractBackgroundTo investigate the prevalence and outcomes of acute gastrointestinal injury (AGI) in critically ill patients with coronavirus disease 2019 (COVID-19).MethodsIn this clinical retrospective study, demographic data, laboratory parameters, AGI grades, clinical severity and outcomes were collected. The primary endpoints were AGI incidence and 28-day mortality, the secondary endpoints were organ dysfunction and septic shock incidence.ResultsFrom February 10 to March 10 2020, 83 critically ill patients of 1314 patients with COVID-19 were enrolled. Seventy-two (86.7%) patients had AGI during hospital stay, of them, 30 had AGI grade I, 35 had AGI grade II, 5 had AGI grade III, and 2 had AGI grade IV. The incidence of AGI grade II and above was 50.6%. As of March 16, 40 (48.2%) patients died within 28 days of admission, the median hospital stay was 12.0 days, ranging from 3 days to 27 days. Multiple organ dysfunction syndrome developed in 58 (69.9%) patients, septic shock in 16 (19.3%) patients. Patients with worse AGI grades had worse clinical variables, higher septic shock incidence and 28-day mortality. Sequential organ failure assessment scores (SOFA) (95% CI, 1.374-2.860; P <0.001), white blood cell (WBC) counts (95% CI, 1.037-1.379; P =0.014), duration of mechanical ventilation (MV) (95% CI, 1.020-1.340; P =0.025) were risk factors for the development of AGI grade II and above. Non-survivors were accompanied by higher incidence of AGI grade III to IV than survivors (17.5% vs. 0.0%, P =0.004).ConclusionsThe AGI incidence was 86.7%, and hospital mortality was 48.2% in critically ill patients with COVID-19. SOFA scores, WBC counts, and duration of MV were risk factors for the development of AGI grade II and above. Patients with worse AGI grades had worse clinical severity variables, higher septic shock incidence and 28-day mortality.

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Predictive value of transabdominal intestinal sonography in critically ill patients: a prospective observational study

Critical Care ◽

10.1186/s13054-019-2645-9 ◽

2019 ◽

Vol 23 (1) ◽

Cited By ~ 1

Author(s):

Tao Gao ◽

Min-Hua Cheng ◽

Feng-Chan Xi ◽

Yan Chen ◽

Chun Cao ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Characteristic Curve ◽

Effective Means ◽

Intestinal Wall ◽

Feeding Intolerance ◽

Gastrointestinal Injury ◽

Increased Risk ◽

Intestinal Peristalsis ◽

Acute Gastrointestinal Injury

Abstract Background This study examined the feasibility of transabdominal intestinal ultrasonography in evaluating acute gastrointestinal injury (AGI). Methods A total of 116 patients were included. Intestinal ultrasonography was conducted daily within 1 week after admission to the intensive care unit. Ultrasonography indicators including intestinal diameter, changes in the intestinal folds, thickness of the intestinal wall, stratification of the intestinal wall, and intestinal peristalsis (movement of the intestinal contents) were observed to determine the acute gastrointestinal injury ultrasonography (AGIUS) score. The gastrointestinal and urinary tract sonography ultrasound (GUTS) protocol score was also calculated. During the first week of the study, the gastrointestinal failure (GIF) score was determined daily. The correlations between transabdominal intestinal scores (AGIUS and GUTS) and the GIF score were analyzed to clarify the feasibility of evaluating AGI through observation of the intestine. The utility of intestinal ultrasonography indicators in predicting feeding intolerance was investigated to improve the ability of clinicians to manage AGI. Results A total of 751 ultrasonic examinations were performed with 511 images (68%) considered to be of “good quality.” AGIUS and GUTS scores differed significantly between AGI patients (GIF score 0–2) and non-AGI patients (GIF score 3–4) (p < 0.001). Both scores correlated positively with GIF score (r = 0.54, p < 0.001; r = 0.66, p < 0.001). These ultrasonography indicators could predict feeding intolerance, with an area under the receiver operating characteristic curve of 0.60 (0.48–0.71; intestinal diameter), 0.76 (0.67–0.85; intestinal folds), 0.71 (0.62–0.80; wall thickness), 0.77 (0.69–0.86; wall stratification), and 0.78 (0.68–0.88; intestinal peristalsis). Compared to patients with a normal rate of peristalsis (5–10/min), patients with abnormal peristalsis rates (< 5/min or > 10/min) have increased risk for feeding intolerance (16/83 vs. 25/33, p < 0.001). Conclusions The transabdominal intestinal ultrasonography represents an effective means for assessing gastrointestinal injury in critically ill patients. Intestinal ultrasonography indicators, especially the degree of intestinal peristalsis, may be used to predict feeding intolerance. Trial registration ClinicalTrial.gov, NCT03589248. Registered 04 July 2018—retrospectively registered.

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Association between acute gastrointestinal injury and biomarkers of intestinal barrier function in critically ill patients

BMC Gastroenterology ◽

10.1186/s12876-017-0603-z ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 11

Author(s):

Hongxiang Li ◽

Ying Chen ◽

Feifei Huo ◽

Yushan Wang ◽

Dong Zhang

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Barrier Function ◽

Intestinal Barrier ◽

Intestinal Barrier Function ◽

Gastrointestinal Injury ◽

Acute Gastrointestinal Injury

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Association between nutrition support and acute gastrointestinal injury in critically ill patients during the first 72 hours

Clinical Nutrition ◽

10.1016/j.clnu.2020.05.011 ◽

2021 ◽

Vol 40 (1) ◽

pp. 217-221

Author(s):

Hongxiang Li ◽

Junying Lu ◽

Hongyan Li ◽

Aosong Duan ◽

Yushan Wang ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Nutrition Support ◽

Gastrointestinal Injury ◽

Acute Gastrointestinal Injury

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Gut rest strategy and trophic feeding in the acute phase of critical illness with acute gastrointestinal injury

Nutrition Research Reviews ◽

10.1017/s0954422419000027 ◽

2019 ◽

Vol 32 (2) ◽

pp. 176-182 ◽

Cited By ~ 5

Author(s):

Dong Zhang ◽

Hongxiang Li ◽

Yuting Li ◽

Lai Qu

Keyword(s):

Critical Illness ◽

Critically Ill ◽

Acute Phase ◽

Critically Ill Patients ◽

Gastrointestinal Dysfunction ◽

Gastrointestinal Injury ◽

Protective Strategy ◽

Current Guidelines ◽

Acute Gastrointestinal Injury ◽

Trophic Feeding

AbstractCritically ill patients frequently suffer from gastrointestinal dysfunction as the intestine is a vulnerable organ. In critically ill patients who require nutritional support, the current guidelines recommend the use of enteral nutrition within 24–48 h and advancing towards optimal nutritional goals over the next 48–72 h; however, this may be contraindicated in patients with acute gastrointestinal injury because overuse of the gut in the acute phase of critical illness may have an adverse effect on the prognosis. We propose that trophic feeding after 72 h, as a partial gut rest strategy, should be provided to critically ill patients during the acute phase of illness as an organ-protective strategy, especially for those with acute gastrointestinal injury.

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Association between acute gastrointestinal injury grading system and disease severity and prognosis in critically ill patients: A multicenter, prospective, observational study in China

Journal of Critical Care ◽

10.1016/j.jcrc.2016.05.001 ◽

2016 ◽

Vol 36 ◽

pp. 24-28 ◽

Cited By ~ 15

Author(s):

Hongxiang Li ◽

Dong Zhang ◽

Yushan Wang ◽

Shujie Zhao

Keyword(s):

Observational Study ◽

Disease Severity ◽

Critically Ill ◽

Critically Ill Patients ◽

Prospective Observational Study ◽

Grading System ◽

Gastrointestinal Injury ◽

Multicenter Prospective Observational Study ◽

Acute Gastrointestinal Injury

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The Prevalence, Risk Factors, and Outcomes of Sepsis in Critically Ill Patients in China: A Multicenter Prospective Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2020.593808 ◽

2020 ◽

Vol 7 ◽

Author(s):

Meiping Wang ◽

Li Jiang ◽

Bo Zhu ◽

Wen Li ◽

Bin Du ◽

...

Keyword(s):

Risk Factors ◽

Septic Shock ◽

Cohort Study ◽

Critically Ill ◽

Fluid Resuscitation ◽

Low Income ◽

Critically Ill Patients ◽

Low Income Countries ◽

Icu Mortality ◽

Tertiary Hospitals

Background: Sepsis is a main cause of morbidity and mortality in critically ill patients. The epidemiology of sepsis in high-income countries is well-known, but information on sepsis in middle- or low-income countries is still deficient, especially in China. The purpose of this study was to explore the prevalence, characteristics, risk factors, treatment, and outcomes of sepsis in critically ill patients in tertiary hospitals in China.Methods: A multicenter prospective observational cohort study was performed with consecutively collected data from adults who stayed in any intensive care unit (ICU) for at least 24 h; data were collected from 1 January 2014 to 31 August 2015, and patients were followed until death or discharge from the hospital.Results: A total of 4,910 patients were enrolled in the study. Of these, 2,086 (42.5%) presented with sepsis or septic shock on admission to the ICU or within the first 48 h after admission to the ICU. ICU mortality was higher in patients with sepsis (13.1%) and septic shock (39.0%) and varied according to geographical region. Acinetobacter, Pseudomonas, and Staphylococcus infections were associated with increased ICU mortality. In addition, age, Acute Physiology, and Chronic Health Evaluation II (APACHE II) scores, pre-existing cardiovascular diseases, malignant tumors, renal replacement therapy (RRT), and septic shock were independent risk factors for mortality in patients with sepsis. The prompt administration of antibiotics (OR 0.65, 95% CI 0.46–0.92) and 30 mL/kg of initial fluid resuscitation during the first 3 h (OR 0.43, 95% CI 0.30–0.63) improved the outcome in patients with septic shock.Conclusions: Sepsis was common and was associated with a high mortality rate in critically ill patients in tertiary hospitals in China. The prompt administration of antibiotics and 30 mL/kg fluid resuscitation decreased the risk of mortality.

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