Related Experiment Video
Updated: May 14, 2026
Observational Study Protocol for Repeated Clinical Examination and Critical Care Ultrasonography Within the Simple Intensive Care Studies
Published on: January 16, 2019
Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective
Annika Reintam Blaser1, Martijn Poeze, Manu L N G Malbrain
1Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, University of Tartu, Tartu, Estonia. annika.reintam@ut.ee
Insights
A higher number of gastrointestinal symptoms in mechanically ventilated patients predicts 28-day mortality. However, a specific gastrointestinal dysfunction score did not improve mortality prediction accuracy.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Prognostic Biomarkers
Background:
- Gastrointestinal (GI) dysfunction is common in critically ill patients.
- Predicting mortality in patients requiring mechanical ventilation (MV) is crucial for clinical decision-making.
Purpose of the Study:
- To develop a novel gastrointestinal dysfunction score to predict 28-day mortality.
- To assess the independent predictive value of GI symptoms and failure on mortality.
Main Methods:
- Prospective study of 377 adult ICU patients requiring MV.
- Documentation of GI symptoms, intra-abdominal pressures, feeding, and organ dysfunction.
- Analysis of GI symptoms and development of a GI dysfunction score.
Main Results:
- Increased number of simultaneous GI symptoms correlated with higher mortality.
- Gastrointestinal failure (GIF), defined as ≥3 GI symptoms, on day 1 predicted a threefold increased mortality risk.
- The developed GI dysfunction score did not improve the predictive performance of the SOFA score for mortality.
Conclusions:
- The number of GI symptoms independently predicts 28-day mortality with moderate accuracy.
- A validated GI dysfunction score that improves SOFA score performance was not achieved.
- GI dysfunction may often be a consequence rather than a primary driver of organ failure in this population.
Purpose:
The study aimed to develop a gastrointestinal (GI) dysfunction score predicting 28-day mortality for adult patients needing mechanical ventilation (MV).
Methods:
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.
Results:
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).
Conclusions:
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.
Related Concept Videos
01:17Assessment of the Gastrointestinal System I: Subjective Data
Health History
The initial step in assessing the GI system is obtaining a comprehensive health history. This includes inquiring about the patient's history or presence of problems related to...
01:30Inflammatory Bowel Disease III: Diagnostic Studies and Management I-Nutritional Therapy
Diagnostic studies
A colonoscopy is the definitive screening test, distinguishing ulcerative colitis from other colon diseases with similar symptoms. During a colonoscopy test, inflamed mucosa with exudate ulcerations can be observed, and biopsies are taken to determine the histologic characteristics of the colonic...
01:07Intestinal Obstruction II: Pathophysiology
01:30Inflammatory Bowel Disease II: Crohn's Disease
Inflammatory bowel disease, commonly known as IBD, refers to a collection of disorders that lead to persistent inflammation of the gastrointestinal tract. The two types of IBD are ulcerative colitis, which impacts the colon, and Crohn's disease, which can involve any part of the gastrointestinal segment.
Crohn's disease
Crohn's disease is a chronic, systemic inflammatory bowel disease (IBD) that predominantly affects the gastrointestinal tract. It is marked by transmural...
01:25Acute Pancreatitis I: Introduction
01:23Gastritis III: Clinical Manifestations and Management
Clinical manifestations of acute gastritis
The patient with acute gastritis may have a rapid onset of symptoms, such as epigastric pain or discomfort, dyspepsia, anorexia, hiccups, or nausea and vomiting, which can last from a few hours to a few days. Erosive or hemorrhagic gastritis may cause bleeding, which may manifest as blood in vomit or as...