Analysis Of Risk Factors And Predictors Associated With Acute Gastrointestinal Injury In Severe Cerebrovascular Disease

Background:Patients with severe cerebrovascular disease suffer from neurological deficits leading to impaired consciousness,swallowing disorders,increased intracranial pressure,and an acute stress state in the organism.They can cause patients to develop gastrointestinal dysfunction,which manifests as feeding intolerance,gastric retention,upper gastrointestinal bleeding,vomiting,diarrhea,and constipation.Early assessment of patients’ risk of developing gastrointestinal dysfunction and active interventions are of great significance for their prognosis.The aim of this paper is to investigate and analyze the incidence,associated risk factors,biological markers and predictors of AGI in patients with severe cerebrovascular disease.Methods:From June 2020 to January 2021,98 patients with severe cerebrovascular disease were collected from the neurological intensive care unit of the first hospital of Jilin University.The European Society of Intensive Care Medicine（ESICM）developed the definitions for GI dysfunction in intensive care patients on the basis of the available evidence and current understanding of the pathophysiology.Definitions for acute gastrointestinal injury（AGI）with its four grades of severity are proposed.AGI is a malfunctioning of the GI tract in intensive care patients due to their acute illness.The general clinical data of patients were collected,including name,gender,age,current medical history,past history,serological indexes and related score scales.The general clinical data of the four groups of patients were compared,and one-way ANOVA,chi-square test,correlation analysis,and multi-factor logistic regression analysis were performed for the factors that may cause gastrointestinal impairment.The risk factors associated with possible gastrointestinal disorders were investigated.Among them,56 patients with combined AGI were tested for guanine,D-lactate,alpha glutathione S-transferase,urea nitrogen,and serum albumin on days 1,4,and 7 of admission to explore the trends in biological indicators.Results:1.98 patients with severe cerebrovascular disease hospitalized in NICU were included,including 9 cases of Ag I 0,38 cases of Ag I I,37 cases of Ag I II and 14 cases of Ag I III.The incidence of Ag I was 90.8%.2.The results of the monofactor analysis showed that there were differences between the four groups in terms of hypertension,smoking,alcohol consumption,NHISS score,GCS score,APACHEII score,the vascular recanalization treatment,dehydrating drugs,sedative drugs,antibiotics,mechanical ventilation<72h,and pneumonia（P<0.05）.3.Among the serological indicators on the first day of patient admission,the difference between leukocytes and CRP was statistically significant（P＜0.05）,and it was positively correlated with AGI grading.4.In the analysis of factors related to the influence of upper gastrointestinal bleeding,the differences in gender,previous history of hypertension,smoking,and alcohol consumption were statistically significant between the two groups（P＜0.05）.5.In the analysis of factors related to the occurrence of vomiting in patients,the use of dehydrating drugs and pro-gastrointestinal motility drugs showed a statistically significant difference between the two groups（P＜0.05）.6.In the analysis of factors related to the influence of the patients’ gastric residual volume,age,use of sedative drugs,and NHISS score at admission were statistically significant differences between the two groups（P＜0.05）.7.56 patients with combined AGI were examined for urea nitrogen,lactate,albumin,citrulline,D-lactate,and α glutathione S-transferase on days 1,4,and 7 after admission.Among them,D-lactic acid,α glutathione S-transferase and urea nitrogen showed a significant increasing trend（P＜0.05）,and albumin showed a decreasing trend after admission（P＜0.05）.8.Multifactorial logistic regression analysis showed that CRP,diabetes mellitus,used of antibiotics,sedation,and whether endovascular opening treatment was performed were independent risk factors for the severity of AGI.9.The results of ROC curves for GCS,NHISS,and APACHEII scores to predict combined gastrointestinal dysfunction in patients with severe cerebrovascular disease were as follows: area under the curve（AUC）GCS score was 0.891,NHISS score was 0.903,APACHEII score was 0.883,GCS+NHISS score was 0.940,GCS+ APACHEII score was0.720,the combination of the three was 0.920,and NHISS+APACHEII score was 0.940,with a maximum AUC,specificity of 77.8%,and sensitivity of 83.1%.Conclusion:1.Patients with severe cerebrovascular disease have a high rate of AGI,which requires a high degree of clinical attention.Be alert to the occurrence of upper gastrointestinal bleeding,gastric residual volume,vomiting,constipation,diarrhea,etc.2.The severity of severe cerebrovascular disease and the degree of neurological deficits correlate with the occurrence of AGI.3.CRP,diabetes,use of antibiotics,sedation,and the presence of endovascular opening therapy are independent risk factors for the severity of AGI.4.Biological markers of early gastrointestinal barrier function（citrulline,D-lactate,α-GST）were consistently elevated after the patient’s admission.5.NHISS score,GCS score and APACHEII score have some predictive value for the occurrence of gastrointestinal dysfunction in patients with severe cerebrovascular disease.