Predictive Value Of Mechanical Ventilation Duration Combined With D-lactic Acid On Grade Of Acute Gastrointestinal Injury

Objective:To explore the effects of mechanical ventilation duration and D-lactic acid(D-LA)on the severity of acute gastrointestinal injury(AGI),determine whether they can be used to indicate the severity of AGI in severe patients,and explore the early prediction value of mechanical ventilation duration combined with D-LA on the severity of acute gastrointestinal injury.Methods:A total of 195 non-surgical and non-traumatic critically ill patients admitted to the ICU and EICU of our Hospital from June 2021 to September 2022were selected.According to the definition of acute gastrointestinal injury and its grading given by the Working Group on Abdominal Problems(WGAP)of the European Society of Critical Care Medicine(ESICM),the enrolled patients meeting the criteria were divided into the non-AGI group(62 cases)and the AGI group(133cases).According to AGI classification,the group was divided into four groups:mild(AGI-ⅰ,18 cases),moderate(AGI-ⅱ,46 cases),severe(AGI-ⅲ,35 cases)and extremely severe(AGI-ⅳ,34 cases).Gender,age,admission diagnosis,APACHEⅡscore on the first day of admission to ICU,highest SOFA score,D-lactic acid(D-LA),diamine oxidase(DAO)and Bacterial endotoxin(Bacterial endotoxin,bacterial endotoxin)measured within 72 hours of admission were collected.BT),procalcitonin(PCT)measured within 24 hours of admission,length of stay in ICU,duration of invasive mechanical ventilation,and 28-day mortality.The differences among the groups were compared,multiple ordered Logistic regression was used to analyze the independent risk factors of AGI grading,and ROC curve was drawn to explore the diagnostic efficiency of mechanical ventilation time combined with D-lactic acid on the severity of AGI.Results:1.A total of 195 patients met the inclusion criteria.There were 122 male patients and 73 female patients,aged 18-92(67.15±14.72)years old.There were 49patients(25.13%)with pulmonary infection,47 patients(24.10%)with respiratory failure,32 patients(16.41%)with heart failure,and 29 patients(14.87%)with cerebral infarction.There were 15 patients with chronic obstructive pulmonary disease(7.68%),14 patients with renal insufficiency(7.18%),and 9 patients with pericardial effusion(4.62%).There was no significant difference in gender composition and age distribution between the two groups with or without AGI(P=0.128;P=0.067),and the length of ICU stay and whether mechanical ventilation was used were significantly different between the two groups(P<0.05;P=0.001).2.Among the 133 patients with AGI,there were significant differences in mechanical ventilation time,D-lactic acid,APACHEⅡscore,SOFA score and 28-day mortality among the four groups(P<0.05),and there were no significant differences in diamine oxidase among different AGI grades(P=0.089).Spearman grade correlation analysis showed that mechanical ventilation time,D-lactic acid,Apachⅱscore and SOFA score were significantly correlated with AGI grade(P<0.01),and all were positively correlated,and mechanical ventilation time was strongly correlated with AGI grade(r_s=0.650).There was a moderate correlation between D-lactic acid and AGI classification(r_s=0.576).Multiple ordered Logistic regression analysis showed that mechanical ventilation time,D-lactic acid and APACHEⅡscore were independent risk factors for AGI classification(P<0.05),but SOFA score was not independent risk factors for AGI classification(P=0.850).3.The ROC curve analysis showed that the AUC area of mechanical ventilation time combined with D-lactic acid in predicting severe AGI(AGI grade≥Ⅲ)was 0.942,which was greater than the independent prediction level of other risk factors(mechanical ventilation time 0.901;D-lactic acid 0.856;APACHEⅡscore 0.763;ICU stay time 0.757;SOFA score of 0.720).The sensitivity and specificity of mechanical ventilation time combined with D-lactic acid diagnosis were 92.8%and 80.2%,and the maximum of Yoden index was 0.729,corresponding to the Cut-off value of(162h,26.82 mg/L),respectively.The sensitivity and specificity of mechanical ventilation time were 87.0%and 82.5%,the maximum value of Yoden index was 0.695,and the corresponding Cut-off value was 116.00h.The maximum Yoden index of D-lactic acid was 0.556,and the corresponding Cut-off value was 27.13 mg/L.The sensitivity and specificity were 82.6%and 73.0%respectively.It can be seen that both mechanical ventilation duration and D-lactic acid have good diagnostic efficacy,and the combined application of the two is better than the independent prediction of various risk factors.Conclusion:Mechanical ventilation time,D-lactic acid and APACHEⅡscore are all independent risk factors for AGI severity,and they are positively correlated with AGI grade.The higher the value,the higher the AGI grade.Mechanical ventilation time combined with D-lactic acid has better diagnostic efficacy for severe AGI,and can predict and identify the severity of gastrointestinal injury in critically ill patients early through quantitative indicators,which has certain value in practical clinical work.