Abstract：Objective To explore the value of a new rating system for acute gastrointestinal injury (AGI) grade combined with multiple factors to predict death in critically ill patients. Methods A single-center retrospective cohort study was used, 658 critically ill patients admitted to ICU at the Second People′s Hospital of Zhaoqing from January 2016 to March 2020 were enrolled. They were divided into death group (112 cases) and survival group (546 cases) according to 28 days survival. The highest grade of AGI within 1 week of admission was evaluated, according to the highest grade to give the score(0-4 points),as the AGI score.Physiological chronic health score(APACHE Ⅱ),sequential organ failure (SOFA) score, MODS score, and MEWS score which of within 24 h of admission in both groups were recorded. Data of two groups were analyzed by one-way analysis, and further Logistic regression analysis was performed factors, screening independent risk factors of death in critically ill patients, and drawing the receiver operating characteristic (ROC) curve of subjects to evaluate the predictive value of a new rating system for acute gastrointestinal injury grading combined with multifactorial critical patient death.Results The age,the AGI score in the first week,APACHE Ⅱ,SOFA score in the death group were higher than those in the survival group, and the differences were statistically significant (P＜0.05). According to the ROC curve, the best diagnostic thresholds for AGI, APACHE Ⅱ, SOFA,and AGE were AGI ≥2 points, APACHE Ⅱ≥21 points, SOFA ≥7 points, and age ≥71 years old. Results of multivariate analysis showed that AGI≥2 points (β=1.608, OR=4.994, 95%CI=3.258-7.654)，APACHE Ⅱ≥21 points(β=0.762, OR=1.587, 95%CI=1.328-1.896), SOFA≥7 points (β=1.590, OR=4.904, 95%CI=3.354-7.171), age≥71 years (β=0.715, OR=1.122, 95%CI=1.063-1.183) were independent risk factors for poor prognosis in critically ill patients (P＜0.05). The ROC curve was drawn for the death warning score, AGI, APACHE Ⅱ, and SOFA score, the death warning score AUC value was 0.909, which was higher than the AUC value of the AGI score, APACHE Ⅱscore and SOFA score alone (0.796, 0.715, 0.805), the differences were statistically significant (P＜0.05). Conclusion The new scoring system of acute gastrointestinal injury rating combined with multi-factor evaluation can warn the death risk of critically ill patients, and the predictive value of critical patients′ death is better than that of any single score.
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