Development of the Gastrointestinal Dysfunction Score (GIDS) for critically ill patients - A prospective multicenter observational study (iSOFA study)

Abstract

Background & aims: To develop a five grade score (0-4 points) for the assessment of gastrointestinal (GI) dysfunction in adult critically ill patients.

Methods: This prospective multicenter observational study enrolled consecutive adult patients admitted to 11 intensive care units in nine countries. At all sites, daily clinical data with emphasis on GI clinical symptoms were collected and intra-abdominal pressure measured. In five out of 11 sites, the biomarkers citrulline and intestinal fatty acid-binding protein (I-FABP) were measured additionally. Cox models with time-dependent scores were used to analyze associations with 28- and 90-day mortality. The models were estimated with stratification for study center.

Results: We included 540 patients (224 with biomarker measurements) with median age of 65 years (range 18-94), the Simplified Acute Physiology Score II score of 38 (interquartile range 26-53) points, and Sequential Organ Failure Assessment (SOFA) score of 6 (interquartile range 3-9) points at admission. Median ICU length of stay was 3 (interquartile range 1-6) days and 90-day mortality 18.9%. A new five grade Gastrointestinal Dysfunction Score (GIDS) was developed based on the rationale of the previously developed Acute GI Injury (AGI) grading. Citrulline and I-FABP did not prove their potential for scoring of GI dysfunction in critically ill. GIDS was independently associated with 28- and 90-day mortality when added to SOFA total score (HR 1.40; 95%CI 1.07-1.84 and HR 1.40; 95%CI 1.02-1.79, respectively) or to a model containing all SOFA subscores (HR 1.48; 95%CI 1.13-1.92 and HR 1.47; 95%CI 1.15-1.87, respectively), improving predictive power of SOFA score in all analyses.

Conclusions: The newly developed GIDS is additive to SOFA score in prediction of 28- and 90-day mortality. The clinical usefulness of this score should be validated prospectively.

Trial registration: NCT02613000, retrospectively registered 24 November 2015.

Keywords: Acute gastrointestinal injury; Critically ill; Gastrointestinal dysfunction; Multiple organ dysfunction; Organ failure.

Conflict of interest statement

Conflict of interest ARB has received speaker fees from Nestlé and Fresenius Kabi. GE has received lecture fees and travel support from Fresenius Kabi, Abbott, and B. Braun Melsungen and advisory honoraria from Fresenius Kabi and Nutricia. MH reports grants and personal fees from Fresenius Kabi, and grants from Abbott. JS has received consulting fees from B. Braun Melsungen and Fresenius Kabi. JCP has received lecture fees from Fresenius, Nestlé and Danone/Nutricia. OR is a consultant for Fresenius Kabi and Nutricia and his institution received a research grant from Fresenius-Kabi. JW has received lecture fees and travel support from Nestle, GE Health Care, and Nutricia. SMJ declares that the Department of Intensive Care Medicine has, or has had in the past, research & development/consulting contracts with Edwards Lifesciences Services GmbH, Phagenesis Limited and Nestlé. The money was paid into a departmental fund, SMJ did not receive any financial gain. The Department of Intensive Care Medicine has received in the past unrestricted educational grants from the following organizations for organizing bi-annual postgraduate courses in the fields of critical care ultrasound, management of ECMO and mechanical ventilation: Pierre Fabre Pharma AG (formerly known as RobaPharm), Pfizer AG, Bard Medica S.A., Abbott AG, Anandic Medical Systems, PanGas AG Healthcare, Orion Pharma, Bracco, Edwards Lifesciences AG, Hamilton Medical AG, Fresenius Kabi (Schweiz) AG, Getinge Group Maquet AG, Dräger Schweiz AG, Teleflex Medical GmbH. BH, CE, CL, CPB, DMM, KF, KT, MG, MM, MPa, MPo, MR, TG and WM declare having no conflicts of interest.

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