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Objective:To investigate the risk factors of acute gastrointestinal failure in patients with traumatic brain injury(TBI).Methods:A retrospective analysis of 297 patients admitted to the Rugao Hospital Affiliated to Nantong University for traumatic brain injury from March 2018 to March 2020 was performed. Multivariate Logistic regression analysis was used to test the risk factors of acute gastrointestinal failure in patients with traumatic brain injury.Results:Of the 297 patients with TBI, 92 (30.98%) had acute gastrointestinal failure, of which 56 (18.86%) were acute gastrointestinal injury(AGI) Ⅲ and 36 (12.12%) were AGI Ⅳ. Multivariate Logistic regression analysis showed that female, low Glasgow Coma Scale (GCS) scores, frontal lobe injury, abnormal serum sodium, lung infection and intracranial infection were independent risk factors for acute gastrointestinal failure in TBI patients ( P<0.05). The length of ICU stay in the acute gastrointestinal failure group was significantly higher than that of the non-acute gastrointestinal failure group: (18.5 ± 2.6) d vs. (6.3 ± 1.2) d, and the incidence of good prognosis was significantly lower than that of the non-acute gastrointestinal failure group: 60.87%(56/92) vs. 80.49(165/205), the differences were statistically significant ( P<0.05). Conclusions:That female, low GCS scores, frontal lobe injury, abnormal serum sodium, lung infection and intracranial infection are independent risk factors for acute gastrointestinal failure in TBI patients
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To investigate the application of Acute Gastrointestinal Injury(AGI) grading in evaluating gastrointestinal failure in patients with acute pancreatitis(AP). In this retrospective observational study,patients presented with moderate severe AP and severe AP in our hospital from October 2013 to October 2016 were consecutively enrolled.Logistic regression analysis and receiver operating characteristic curve were used to explore and evaluate potential predictors of gastrointestinal failure. A total of 202 patients were included in this study,with 90 cases(44.6%) identified as gastrointestinal failure.Survival curve showed significantly increased risk of death in patients with gastrointestinal failure( < 0.05).Logistic regression analysis showed age(=1.06,95%:1.03-1.09,<0.001),complaint of stopping flatus and defecation(=7.02,95%:2.08-23.66,=0.002),increased counts of white blood cells in peripheral blood(=1.09,95%:1.02-1.17,=0.015),decreased level of serum albumin(=0.93,95%:0.86-1.00,=0.048),and increased level of serum creatinine at admission(=1.02,95%:1.01-1.04,=0.001) were the independent risk factors of gastrointestinal failure.The area under curves of Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Beside Index for Severity in Acute Pancreatitis (BISAP) scores in diagnosing gastrointestinal failure were 0.999 and 0.782,respectively. Gastrointestinal failure can remarkably increase the risk of death in patients with AP.Both APACHE Ⅱ and BISAP scores at admission are useful in diagnosing gastrointestinal failure in patients with AP.
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Objective To evaluate the relationship between the Trefoil factor 3 (TFF3) serum,concentration and gastrointestinal failure(GIF) and discuss eaely diagnosis,treatment and prognosis in patients with GIF after esophageal cancer surgery.Methods To test the TFF3 levels of the serum during the postoperation of esophageal cancer by ELISA.Results Serum TFF3 concentrations measured prior to the occurrence of GIF were significantly higher than in control group (P ＜ 0.01).serum TFF3 concentration was significantly related to gastrointestinal tract function score(r =-0.712).Cox proportional hazards model analysis showed that the serum TFF3 concentrations at the time of occurrence of gastrointestinal failure,and 48 hours later,could be used as prognostic factors in critically ill pediatric patients with GIF(r =1.443 and 1.872,respectively).Conclusion TFF3 may play an important role in predicting GIF in pediatric critical illness and has a protective function in the mucosal repair process.
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Gastrointestinal failure is often secondary to a variety critically illness such as sepsis,severe hypoxia and severe gastrointestinal diseases and characterized gastrointestinal mucous lesion,dysfunction of gastrointestinal motility and barrier.It is a pivotal factor influencing the outcome of critically ill patients.Early diagnosis and appropriate treatment is important to improve the outcome of patients,but for a long time there was no unified definition and standard of diagnosis and also no consensus of therapeutic regimen because of lacking specific criteria of assessment.In recent years,the new conception of acute gastrointestinal injury with its four grades of severity and therapeutic regimen based on the grades were proposed in adult ICU field which is worth learning for pediatrician.In this review,the etiology of gastrointestinal failure and the new concepts on its different grades and grading treatment were discussed.