Gastrointestinal failure score alone and in combination with SOFA score in the assessment of the critically ill patients

Introduction: The gut plays a major role in critical illness. Gastrointestinal problems occur frequently and are associated with an adverse outcome in critically ill patients despite that, gastrointestinal (GI) function is not included in any of the widely used scoring systems assessing organ failures in critical illness. Monitoring of intra-abdominal pressure (IAP) is gaining more and more popularity in everyday clinical practice. Several studies have demonstrated an impact of intra-abdominal hypertension (IAH) on mortality. With the goal of developing a scoring system for GI failure, Reintam, et al. combined GI symptoms and IAH into a five-grade scale-the Gastrointestinal Failure Score and tested it among critically ill patients in Estonian intensive care unit. Aim of the Study: Our study is to evaluate the GIF score in our Egyptian intensive care units regarding validity and impact on mortality and comparing this with the SOFA score. And to describe the prevalence of food intolerance and intraabdominal hypertension among ICU patients and their impact on mortality. Patients and Methods: We studied 109 mechanically ventilated patients day one admitted to the general ICU of Kasr El-Aini Hospital and Theodor Bilharz Research institute in the period from March 2009 to November 2009. The SOFA+GIF score was calculated each day by summarizing the SOFA score and the GIF score of the respective day in each patient. Results: FI developed in 35.8%, IAH in 26.9% and both of them together in 14.7% of all patients. Compared to patients with mean GIF=0, patients with mean GIF higher than 0 and lower than or equal 2 and mean GIF higher than 2 show higher ICU mortality (100%, 81.4% vs 48.2% p-value 0.0001 respectively). The GIF score integrated into the SOFA score allowed a better prediction of ICU mortality than the SOFA score.