The impact of gastrointestinal failure on intensive care unit mortality

Objective

To determine the incidence of gastrointestinal failure (GIF) in the ICU and its impact on mortality.

Methods

A retrospective study on adult patients (n = 2588) admitted to three ICUs (two ICUs at Berlin Charité, Germany and one ICU at Tartu University Hospital, Estonia) during the year 2002 was performed. GIF was defined as documented gastrointestinal problems (including food intolerance, gastrointestinal haemorrhage and ileus). The risk ratio (RR) and odds ratio (OR) were calculated to evaluate GIF as a risk factor of death.

Results

A total of 252 patients (9.7%) developed GIF during the ICU stay. We showed that in patients who develop GIF the risk of death increases remarkably. The most dramatic rise in risk of death occurred in elective cardiosurgical patients in Berlin, with risk ratio 23.4 and OR 31.82. The risk of death rose also in surgical and medical emergency patients (RR 5.5; OR 9.21 in Berlin and RR 3.2; OR 7.67 in Tartu).

By evaluating patients according to their maximum SOFA score, we demonstrated that patients with GIF had lower survival rates compared with nonGIF patients. The incidence of GIF significantly raised the risk of death in patients with SOFAmax <12 (P < 0.001; Table 1), while in patients with SOFAmax of 12 or more points differences between the GIF and nonGIF cohorts were not significant.

Table 1

Conclusions

Development of GIF has an impact on ICU mortality. Using GIF together with the SOFA score might be helpful for estimating the risk of death in ICU patients. Further studies are needed for establishing a proper definition of GIF.