Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jan;26(1):181-190.
doi: 10.1007/s11605-021-05015-z. Epub 2021 Apr 27.

Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients

Panagiotis Drakos #  1 , Panagiotis Volteas #  1 , Nathaniel A Cleri  2 , Leor N Alkadaa  2 , Anthony A Asencio  2 , Anthony Oganov  2 , Aurora Pryor  1   3 , Mark Talamini  1 , Jerry Rubano  1 , Mohsen Bannazadeh  1   4 , Charles B Mikell  2 , Konstantinos Spaniolas  5   6 , Sima Mofakham  7
Affiliations

Acute Gastrointestinal Injury and Feeding Intolerance as Prognostic Factors in Critically Ill COVID-19 Patients

Panagiotis Drakos et al. J Gastrointest Surg. 2022 Jan.

Abstract

Background: Although acute gastrointestinal injury (AGI) and feeding intolerance (FI) are known independent determinants of worse outcomes and high mortality in intensive care unit (ICU) patients, the incidence of AGI and FI in critically ill COVID-19 patients and their prognostic importance have not been thoroughly studied.

Methods: We reviewed 218 intubated patients at Stony Brook University Hospital and stratified them into three groups based on AGI severity, according to data collected in the first 10 days of ICU course. We used chi-square test to compare categorical variables such as age and sex and two-sample t-test or Mann-Whitney U-tests for continuous variables, including important laboratory values. Cox proportional hazards regression models were utilized to determine whether AGI score was an independent predictor of survival, and multivariable analysis was performed to compare risk factors that were deemed significant in the univariable analysis. We performed Kaplan-Meier survival analysis based on the AGI score and the presence of FI.

Results: The overall incidence of AGI was 95% (45% AGI I/II, 50% AGI III/IV), and FI incidence was 63%. Patients with AGI III/IV were more likely to have prolonged mechanical ventilation (22 days vs 16 days, P-value <0.002) and higher mortality rate (58% vs 28%, P-value <0.001) compared to patients with AGI 0/I/II. This was confirmed with multivariable analysis which showed that AGI score III/IV was an independent predictor of higher mortality (AGI III/IV vs AGI 0/I/II hazard ratio (HR), 2.68; 95% confidence interval (CI), 1.69-4.25; P-value <0.0001). Kaplan-Meier survival analysis showed that both AGI III/IV and FI (P-value <0.001) were associated with worse outcomes. Patients with AGI III/IV had higher daily and mean D-dimer and CRP levels compared to AGI 0/I/II (P-value <0.0001).

Conclusions: The prevalence of AGI and FI among critically ill COVID-19 patients was high. AGI grades III/IV were associated with higher risk for prolonged mechanical ventilation and mortality compared to AGI 0/I/II, while it also correlated with higher D-dimer and C-reactive protein (CRP) levels. FI was independently associated with higher mortality. The development of high-grade AGI and FI during the first days of ICU stay can serve as prognostic tools to predict outcomes in critically ill COVID-19 patients.

Keywords: Acute gastrointestinal injury (AGI); COVID-19; CRP; Critically ill; D-dimers; Feeding intolerance (FI).

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Dr. Pryor received honoraria for speaking for Ethicon, Gore, Medtronic, Merck, and Stryker and is a consultant for Obalon. Dr. Spaniolas receives research support from Merck; he is a speaker for Gore. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Patient selection algorithm
Fig. 2
Fig. 2
SOFA score at the time of intubation, between patients with AGI 0/I/II and AGI grades III/IV
Fig. 3
Fig. 3
Comparison of cumulative survival rate among patients with AGI 0/I/II and AGI grades III/IV
Fig. 4
Fig. 4
Comparison of cumulative survival rate among patients with FI (n=138) and no FI (n=79)
Fig. 5
Fig. 5
D-dimer and CRP levels over 30 days post-initial intubation among patients with AGI 0/I/II and AGI grades III/IV
See this image and copyright information in PMC

References

    1. https://www.worldometers.info/coronavirus/
    1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8:475–481. doi: 10.1016/S2213-2600(20)30079-5. - DOI - PMC - PubMed
    1. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323(11):1061-1069. doi: 10.1001/jama.2020.1585. PMID: 32031570; PMCID: PMC7042881. - PMC - PubMed
    1. Reintam Blaser A, Malbrain ML, Starkopf J, Fruhwald S, Jakob SM, De Waele J, Braun JP, Poeze M, Spies C. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012 Mar;38(3):384-94. 10.1007/s00134-011-2459-y. Epub 2012 Feb 7. PMID: 22310869; PMCID: PMC3286505. - PMC - PubMed
    1. Hu B, Sun R, Wu A, Ni Y, Liu J, Guo F, Ying L, Ge G, Ding A, Shi Y, Liu C, Xu L, Jiang R, Lu J, Lin R, Zhu Y, Wu W, Xie B. Severity of acute gastrointestinal injury grade is a predictor of all-cause mortality in critically ill patients: a multicenter, prospective, observational study. Crit Care. 2017;21:188. doi: 10.1186/s13054-017-1780-4. - DOI - PMC - PubMed

Publication types