A correction for this article has been published in Critical Care 2008, 12:435

Research

Gastrointestinal Failure score in critically ill patients: a prospective observational study

Annika Reintam^1,2 , Pille Parm³ , Reet Kitus^1,3 , Joel Starkopf^1,3 and Hartmut Kern^1,4

¹Clinic of Anaesthesiology and Intensive Care, University of Tartu, Puusepa, Tartu 51014, Estonia

²Department of Anaesthesiology and Intensive Care, East Tallinn Central Hospital, Ravi, Tallinn 10138, Estonia

³Clinic of Anaesthesiology and Intensive Care, Tartu University Hospital, Puusepa, Tartu 51014, Estonia

⁴Klinik für Anästhesiologie und Intensivmedizin, DRK Kliniken Berlin Köpenick, Salvador-Allende-Straße, Berlin 12559, Germany

author email corresponding author email

Critical Care 2008, 12:R90doi:10.1186/cc6958

Published:	14 July 2008

See related commentary by Khadaroo and Marshall, http://ccforum.com/content/12/5/180, and related letter by Berger et al., http://ccforum.com/content/12/6/436

Abstract

Introduction

There are no universally accepted diagnostic criteria for gastrointestinal failure in critically ill patients. In the present study we tested whether the occurrence of food intolerance (FI) and intra-abdominal hypertension (IAH), combined in a 5-grade scoring system for assessment of gastrointestinal function (the Gastrointestinal Failure [GIF] score), predicts mortality. The prognostic value of the GIF score alone and in combination with the Sequential Organ Failure Assessment (SOFA) score is evaluated, and the incidence and outcome of gastrointestinal failure is described relative to the GIF score.

Methods

A total of 264 subsequently hospitalized patients, who were mechanically ventilated on admission and stayed in the intensive care unit (ICU) for longer than 24 hours, were prospectively studied. GIF score was documented daily as follows: 0 = normal gastrointestinal function; 1 = enteral feeding with under 50% of calculated needs or no feeding 3 days after abdominal surgery; 2 = FI or IAH; 3 = FI and IAH; and 4 = abdominal compartment syndrome (ACS). Admission parameters and mean GIF and SOFA scores for the first 3 days were used to predict ICU outcome.

Results

FI developed in 58.3%, IAH in 27.3%, and both together in 22.7% of patients. The mean GIF score for the first 3 days in the ICU was identified as an independent risk factor for mortality (odds ratio = 3.02, 95% confidence interval = 1.63 to 5.59; P < 0.001). The GIF score integrated into the SOFA score allowed better prediction of ICU mortality than did the SOFA score alone, and was an independent predictor of mortality (odds ratio = 1.49, 95% confidence interval = 1.28 to 1.74; P < 0.001). The development of gastrointestinal failure (FI plus IAH) was associated with significantly higher ICU and 90-day mortality.

Conclusion

The GIF score is useful for classifying information on the gastrointestinal system. The mean GIF score during the first 3 days in the ICU had high prognostic value for ICU mortality. Development of gastrointestinal failure is associated with significantly impaired outcome.