Risk Factor Analysis And Prognostic Evaluation Of Acute Gastrointestinal Failure In Critically Ill Patients With Traumatic Brain Injury

Objective:To study the prevalence of acute gastrointestinal injury(AGI)in critically ill patients with traumatic brain injury(TBI).Analyze the risk factors of acute gastrointestinal failure(AGF)in critically ill patients with TBI and evaluate the effects of AGF following TBI on clinical outcomes.Methods:A prospective observational study was conducted in the Department of general intensive care unit and Department of Neurosurgery intensive care unit of NanFang Hospital from June 1st 2017 to June 1st 2018.New critically ill patients with TBI,meeting the research criteria,were enrolled and their clinical data were collected on admission,during ICU stay,and prognostic data when transferred out of ICU.According to AGI criterion proposed by the Working Group on Abdominal Problems of the European Society of Intensive Care Medicine(ESICM)in 2012,AGI was divided into grade Ⅰ-Ⅳ,and we defined grade 0 was no AGI.During the ICU stay,the patients with their highest AGI grade which was 0 or Ⅰ or Ⅱ were classified as low-grade AGI group,and those with grade Ⅲ or Ⅳ AGI were classified as AGF group.The risk factors of AGF after TBI were screened by univariate analysis and binary logistic multivariate regression analysis.Univariate analysis were performed between the prognostic data of two groups to study the impact of AGF on TBI clinical outcomes.Results:1.A total of 112 critically ill patients with TBI were admitted,4.5%of TBI critically ill patients had no AGI,95.5%of TBI critically ill patients had AGI of grade I-IV,while the patients of AGF accounted for 32.1%of the total.2.Univariate analysis results showed that TBI head injury parts,severe disturbance of consciousness(GCS≤8)when admitted,mechanical ventilation time more than 1 day,tracheotomy,shock,pulmonary infection and intracranial infection,serum sodium disorder,serum potassium disorder,serum calcium disorder,severe hypoalbuminemia,moderate and severe anemia,as well as coagulation dysfunction during ICU stay were significantly different between the TBI critically ill patients with AGF and low-grade AGI group(no AGF group).Binary logistic multivariate regression analysis results showed that severe disturbance of consciousness(GCS≤8)when admitted,serum sodium disorder as well as pulmonary infection during ICU stay were the significant factors of AGF in TBI critically ill patients.3.Critically ill patients with AGF after TBI,compared with those with no AGF after TBI,showed longer ICU stay(20.50±15.913 d vs 7.24±6.483 d)and higher incidence of low Glasgow Outcome Scale grade(36.1%vs 17.1%).Conclusions:1.AGI in critically ill patients with TBI is of high incidence and also severe.Our research shows that the incidence of AGI and AGF in critically ill patients with TBI are 95.5%and 32.1%respectively.2.TBI head injury parts,severe disturbance of consciousness(GCS≤8)when admitted,mechanical ventilation time more than 1 day,tracheotomy,shock,pulmonary infection and intracranial infection,serum sodium disorder,serum potassium disorder,serum calcium disorder,severe hypoalbuminemia,moderate and severe anemia,as well as coagulation dysfunction during ICU stay can be the possible risk factors of AGF in critically ill patients with TBI.Among them severe disturbance of consciousness(GCS≤8)when admitted,serum sodium disorder as well as pulmonary infection during ICU stay are the independent risk factors of AGF in critically ill patients with TBI.3.TBI critically ill patients with AGF obviously have worse clinical outcomes,including longer ICU stay and lower GOS grade,than those without.