Introduction
Methods
General
Definitions
Statistical analysis
Results
Characteristics | All (n = 377) | Survivors (n = 260) | Nonsurvivors (n = 117) |
P value |
---|---|---|---|---|
Admission | ||||
Age, years, median (range) | 62 (18–98) | 61 (18–98) | 64 (22–91) | 0.082 |
Body mass index | 26 (23–29) | 26 (23–29) | 25(22–29) | 0.086 |
Medical profile, n (%) | 142 (37.7) | 84 (32.3) | 58 (49.6) | 0.001 |
Abdominal surgery, n (%) | 118 (31.3) | 90 (34.6) | 28 (23.9) | 0.042 |
Day 1 | ||||
APACHE II score, points | 18 (13–24) | 17 (12–22) | 21 (17–30) | <0.001 |
Sepsis, n (%) | 137 (36.3) | 82 (31.5) | 55 (47.0) | 0.005 |
SOFA score (points) | 8 (5–10) | 7 (5–10) | 10 (7–14) | <0.001 |
Vasopressors, n (%) | 263 (69.8) | 172 (66.2) | 91 (77.8) | 0.029 |
pO2/FiO2 (mmHg) | 188 (108–322) | 193 (115–347) | 177 (97–292) | 0.151 |
Creatinine (μmol/L) | 99 (72–164) | 91 (69–139) | 126 (80–188) | <0.001 |
Glasgow coma scale (points) | 13 (6–15) | 14 (7–15) | 10 (4–15) | <0.001 |
Fluid balance (L/24 h) | +1.4 (0.4–2.9) | +1.1 (0.2–2.7) | +2.0 (1.0–3.5) | 0.001 |
Urine output (L/24 h) | 1.6 (0.9–2.6) | 1.8 (1.0–2.7) | 1.2 (0.4–2.3) | <0.001 |
Mean IAP (mmHg) | 9.8 (7.0–12.7) | 10.0 (7.3–12.8) | 9.0 (5.9–12.6) | 0.066 |
Minimal APP (mmHg) | 62 (52–71) | 62 (53–72) | 60 (46–70) | 0.033 |
Number of GI symptoms | 0 (0–1) | 0 (0–1) | 1 (0–1) | 0.013 |
Three or more GI symptoms, n (%) | 18 (4.8) | 7 (2.7) | 11 (9.4) | 0.008 |
Day 1 | Day 2 | Day 4 | Day 7 | Cumulative | |
---|---|---|---|---|---|
Total number of patients | 377 | 352 | 264 | 200 | 377 |
Survivors | 260 | 244 | 194 | 147 | 260 |
Nonsurvivors | 117 | 106 | 70 | 53 | 117 |
Median (IQR) number of GI symptoms | Cumulative maximum#
| ||||
Total | 1 (0–1) | 0 (0–1) | 0 (0–1) | 0 (0–1) | 1 (0–2) |
Survivors | 0 (0–1) | 0 (0–1) | 0 (0–1) | 0 (0–1) | 1 (0–1) |
Nonsurvivors | 1 (0–1) | 1 (0–1) | 1 (0–1) | 1 (0–1) | 1 (0–2) |
P value* | <0.001 | <0.001 | <0.001 | <0.001 | <0.001 |
Absent bowel sounds | |||||
Total (%) | 125 (33.2) | 82 (23.3) | 42 (15.9) | 29 (14.9) | 142 (37.7) |
Survivors (%) | 76 (29.2) | 45 (18.4) | 25 (12.9) | 15 (10.3) | 88 (33.8) |
Nonsurvivors (%) | 49 (41.9) | 37 (34.9) | 17 (24.3) | 14 (28.6) | 54 (46.2) |
P value* | 0.018 | <0.001 | 0.033 | 0.009 | 0.022 |
Diarrhoea | |||||
Total (%) | 26 (6.9) | 40 (11.2) | 46 (17.4) | 39 (19.5) | 81 (21.5) |
Survivors (%) | 16 (6.2) | 20 (8.2) | 31 (16.0) | 26 (17.7) | 53 (20.4) |
Nonsurvivors (%) | 10 (8.5) | 20 (18.9) | 15 (21.4) | 13 (24.5) | 28 (23.9) |
P value* | 0.388 | 0.006 | 0.270 | 0.314 | 0.498 |
Bowel distension | |||||
Total (%) | 54 (14.3) | 53 (15.1) | 32 (12.9) | 19 (9.5) | 78 (20.7) |
Survivors (%) | 33 (12.7) | 34 (13.9) | 21 (11.5) | 10 (6.8) | 48 (18.5) |
Nonsurvivors (%) | 21 (17.9) | 19 (17.9) | 11 (16.7) | 9 (17.0) | 30 (25.6) |
P value* | 0.202 | 0.325 | 0.275 | 0.049 | 0.129 |
Vomiting/regurgitation | |||||
Total (%) | 18 (4.8) | 11 (3.1) | 5 (1.9) | 7 (3.5) | 31 (15.5) |
Survivors (%) | 11 (4.2) | 7 (2.9) | 3 (1.5) | 5 (3.4) | 22 (8.5) |
Nonsurvivors (%) | 7 (6.0) | 4 (3.8) | 2 (2.9) | 2 (3.8) | 9 (7.7) |
P value* | 0.445 | 0.738 | 0.611 | 1.000 | 1.000 |
High gastric residual volume | |||||
Total (%) | 13 (3.4) | 8 (2.3) | 8 (3.0) | 8 (4.0) | 28 (7.4) |
Survivors (%) | 8 (3.1) | 5 (2.4) | 5 (2.6) | 5 (3.4) | 15 (5.8) |
Nonsurvivors (%) | 5 (4.3) | 3 (2.8) | 3 (4.3) | 3 (5.7) | 13 (11.1) |
P value* | 0.556 | 0.706 | 0.712 | 0.697 | 0.086 |
Gastrointestinal bleeding | |||||
Total (%) | 16 (4.2) | 13 (3.7) | 5 (1.9) | 4 (2.0) | 24 (6.4) |
Survivors (%) | 7 (2.7) | 4 (1.6) | 2 (1.0) | 2 (1.4) | 11 (4.2) |
Nonsurvivors (%) | 9 (7.7) | 9 (8.5) | 3 (4.3) | 2 (3.8) | 13 (11.1) |
P value* | 0.049 | 0.003 | 0.116 | 0.270 | 0.020 |
At least 1 GI symptom | |||||
Total | 168 (44.6) | 146 (41.7) | 109 (41.3) | 81 (40.5) | 227 (60.2) |
Survivors | 105 (40.4) | 88 (33.8) | 71 (27.3) | 51 (19.6) | 148 (56.9) |
Nonsurvivors | 63 (53.8) | 58 (49.6) | 38 (32.5) | 30 (25.6) | 79 (67.5) |
P value* | 0.019 | 0.001 | 0.011 | 0.009 | 0.054 |
2 or more GI symptoms | |||||
Total | 62 (16.4) | 46 (13.1) | 21 (8.0) | 20 (10.0) | 76 (20.2) |
Survivors | 39 (15.0) | 24 (9.2) | 13 (5.0) | 10 (3.8) | 44 (16.9) |
Nonsurvivors | 23 (19.7) | 22 (18.8) | 8 (6.8) | 10 (8.5) | 32 (27.4) |
P value* | 0.293 | 0.009 | 0.203 | 0.017 | 0.026 |
3 or more GI symptoms = GI failure | |||||
Total (%) | 18 (4.8) | 11 (3.1) | 6 (2.3) | 3 (1.5) | 24 (6.4) |
Survivors (%) | 7 (2.7) | 2 (0.8) | 1 (0.5) | 1 (0.7) | 9 (3.5) |
Nonsurvivors (%) | 11 (9.4) | 9 (8.5) | 5 (7.1) | 2 (3.8) | 15 (12.8) |
P value* | 0.008 | 0.001 | 0.006 | 0.172 | 0.001 |
4 or more GI symptoms | |||||
Total | 4 (1.1) | 11 (3.1) | 0 | 1 (0.5) | 16 (4.2) |
Survivors | 2 (0.8) | 2 (0.8) | 0 | 1 (0.4) | 5 (1.9) |
Nonsurvivors | 2 (1.7) | 9 (7.7) | 0 | 0 | 11 (9.4) |
P value* | 0.591 | 0.001 | 0.002 | ||
Intra-abdominal hypertension | |||||
Total (%) | 109 (28.9) | 96 (27.4) | 68 (25.8) | 40 (20.0) | 161 (42.7) |
Survivors (%) | 77 (29.6) | 71 (29.1) | 55 (28.4) | 32 (21.8) | 111(42.7) |
Nonsurvivors (%) | 32 (27.4) | 25 (23.6) | 13 (18.6) | 8 (15.1) | 50 (42.7) |
P value* | 0.713 | 0.421 | 0.105 | 0.305 | 1.000 |
Day 1 |
P value | OR | Lower CI 95 % | Upper CI 95 % |
---|---|---|---|---|
Absent bowel sounds |
0.007
|
2.457
| 1.285 | 4.700 |
Vomiting/regurgitation | 0.877 | 0.903 | 0.25 | 3.258 |
Maximum GRV > 500 ml | 0.888 | 0.910 | 0.244 | 3.397 |
Diarrhoea | 0.387 | 1.700 | 0.511 | 5.659 |
Bowel distension | 0.916 | 0.954 | 0.398 | 2.289 |
GI bleeding |
0.042
|
4.404
|
1.058
|
18.333
|
EN < 80 % of caloric needs |
0.032
|
0.325
|
0.116
|
0.906
|
IAH | 0.316 | 0.708 | 0.361 | 1.390 |
DAY 2 | ||||
Absent bowel sounds | 0.425 | 1.368 | 0.633 | 2.957 |
Vomiting/regurgitation | 0.887 | 1.120 | 0.234 | 5.352 |
Maximum GRV > 500 ml | 0.673 | 1.392 | 0.300 | 6.469 |
Diarrhoea | 0.408 | 1.640 | 0.508 | 5.289 |
Bowel distension | 0.759 | 1.162 | 0.445 | 3.030 |
GI bleeding |
0.008
|
19.093
|
2.153
|
169.336
|
EN < 80 % of caloric needs |
0.040
|
0.355
|
0.132
|
0.952
|
IAH | 0.062 | 0.461 | 0.204 | 1.041 |
DAY 4 | ||||
Absent bowel sounds | 0.192 | 1.793 | 0.746 | 4.310 |
Vomiting/regurgitation | 0.366 | 3.147 | 0.263 | 37.699 |
Maximum GRV > 500 ml | 0.398 | 1.995 | 0.402 | 9.901 |
Diarrhoea | 0.361 | 1.642 | 0.567 | 4.758 |
Bowel distension | 0.829 | 1.122 | 0.396 | 3.173 |
GI bleeding | 0.150 | 5.595 | 0.538 | 58.177 |
EN < 80 % of caloric needs | 0.440 | 1.437 | 0.573 | 3.605 |
IAH | 0.127 | 0.512 | 0.217 | 1.210 |
DAY 7 | ||||
Absent bowel sounds | 0.162 | 2.157 | 0.735 | 6.332 |
Vomiting/regurgitation | 0.230 | 0.162 | 0.008 | 3.158 |
Maximum GRV > 500 ml | 0.636 | 1.490 | 0.285 | 7.790 |
Diarrhea | 0.793 | 1.181 | 0.342 | 4.083 |
Bowel distension |
0.036
|
7.070
|
1.140
|
43.859
|
GI bleeding | 0.249 | 3.822 | 0.392 | 37.281 |
EN < 80 % of caloric needs | 0.951 | 0.970 | 0.364 | 2.582 |
IAH | 0.153 | 0.428 | 0.134 | 1.372 |
P value | Odds ratio | 95 % CI | |
---|---|---|---|
Age | 0.542 | 1.005 | 0.990–1.019 |
Body mass index | 0.207 | 0.971 | 0.929–1.016 |
Medical profile | 0.083 | 1.598 | 0.940–2.716 |
Sepsis | 0.223 | 1.400 | 0.815–2.406 |
Fluid balance day 1 | 0.859 | 1.000 | 1.000–1.000 |
Three or more GI symptoms day 1 |
0.035
|
3.189
|
1.082–9.396
|
Renal SOFA sub-score |
<0.001
|
1.423
|
1.169–1.733
|
Neurological SOFA sub-score |
<0.001
|
1.444
|
1.231–1.694
|
Haematologic SOFA sub-score | 0.073 | 1.277 | 0.977–1.668 |
Respiratory SOFA sub-score | 0.311 | 1.113 | 0.905–1.368 |
Hepatic SOFA sub-score | 0.804 | 0.962 | 0.710–1.305 |
Cardiovascular SOFA sub-score | 0.859 | 0.982 | 0.808–1.195 |
SOFA sub-scores + number of GI symptoms, and survival | ||||
---|---|---|---|---|
Day 1 |
P value | OR | Lower CI 95 % | Upper CI 95 % |
SOFA cardiovascular | 0.757 | 1.030 | 0.854 | 1.242 |
SOFA respiratory | 0.133 | 1.158 | 0.956 | 1.403 |
SOFA haematologic | 0.075 | 1.261 | 0.977 | 1.628 |
SOFA hepatic | 0.774 | 0.958 | 0.718 | 1.280 |
SOFA renal | <0.001 | 1.441 | 1.193 | 1.740 |
SOFA neurological | <0.001 | 1.469 | 1.262 | 1.710 |
Number of GI symptoms | 0.089 | 1.264 | 0.965 | 1.656 |
Day 2 | ||||
SOFA cardiovascular | 0.799 | 1.025 | 0.847 | 1.240 |
SOFA respiratory | 0.261 | 1.119 | 0.919 | 1.363 |
SOFA haematologic | 0.286 | 1.151 | 0.889 | 1.491 |
SOFA hepatic | 0.738 | 0.940 | 0.653 | 1.353 |
SOFA renal | 0.007 | 1.309 | 1.077 | 1.592 |
SOFA neurological | <0.001 | 1.331 | 1.146 | 1.546 |
Number of GI symptoms | 0.002 | 1.606 | 1.184 | 2.179 |
Day 4 | ||||
SOFA cardiovascular | 0.961 | 1.006 | 0.801 | 1.263 |
SOFA respiratory | 0.447 | 1.105 | 0.854 | 1.432 |
SOFA haematologic | 0.364 | 1.156 | 0.846 | 1.579 |
SOFA hepatic | 0.771 | 1.061 | 0.713 | 1.577 |
SOFA renal | 0.009 | 1.381 | 1.083 | 1.762 |
SOFA neurological | 0.001 | 1.348 | 1.122 | 1.620 |
Number of GI symptoms | 0.054 | 1.505 | 0.993 | 2.282 |
Day 7 | ||||
SOFA cardiovascular | 0.133 | 1.227 | 0.940 | 1.603 |
SOFA respiratory | 0.656 | 1.075 | 0.782 | 1.478 |
SOFA haematologic | 0.045 | 1.502 | 1.008 | 2.237 |
SOFA hepatic | 0.371 | 0.806 | 0.503 | 1.292 |
SOFA renal | 0.588 | 1.082 | 0.814 | 1.438 |
SOFA neurological | 0.045 | 1.238 | 1.005 | 1.525 |
Number of GI symptoms | 0.010 | 1.882 | 1.164 | 3.042 |
Cumulative maximum | ||||
SOFA cardiovascular | 0.454 | 1.080 | 0.883 | 1.320 |
SOFA respiratory | 0.390 | 1.101 | 0.884 | 1.371 |
SOFA haematologic | 0.561 | 1.072 | 0.847 | 1.357 |
SOFA hepatic | 0.888 | 1.020 | 0.777 | 1.338 |
SOFA renal | <0.001 | 1.475 | 1.246 | 1.747 |
SOFA neurological | <0.001 | 1.452 | 1.254 | 1.681 |
Number of GI symptoms | 0.082 | 1.267 | 0.971 | 1.655 |
SOFA | AUC | SE | 95 %CI |
---|---|---|---|
Day 1 | 0.703 | 0.03 | 0.643–0.762 |
Day 2 | 0.682 | 0.03 | 0.616–0.748 |
Day 4 | 0.696 | 0.04 | 0.620–0.772 |
Day 7 | 0.691 | 0.05 | 0.602–0.780 |
Cumulative maximum | 0.732 | 0.03 | 0.676–0.789 |
Number of GI symptoms | |||
Day 1 | 0.571 | 0.03 | 0.508–0.635 |
Day 2 | 0.607 | 0.03 | 0.541–0.673 |
Day 4 | 0.591 | 0.02 | 0.512–0.670 |
Day 7 | 0.624 | 0.05 | 0.533–0.714 |
Cumulative maximum | 0.581 | 0.01 | 0.517–0.644 |
SOFA + number of GI symptoms | |||
Day 1 | 0.706 | 0.03 | 0.647–0.766 |
Day 2 | 0.687 | 0.03 | 0.622–0.752 |
Day 4 | 0.698 | 0.04 | 0.623–0.772 |
Day 7 | 0.700 | 0.04 | 0.614–0.785 |
Cumulative maximum | 0.734 | 0.03 | 0.678–0.790 |