Validation of the GastroIntestinal Dysfunction Score (GIDS): prospective observational multicentre study (GUTPHOS Study)

The present multicentre, prospective cohort study of intensive care unit (ICU) patients aims to validate the recently developed Gastrointestinal Dysfunction Score (GIDS) against mortality, given the absence of gold standard for respective organ dysfunction assessment. Consecutive adult patients admitted to ICUs worldwide were included from 28 ICUs worldwide between January and August 2024, with a maximum of 120 patients per site during an eight-week study period. Patients were monitored daily from ICU admission to discharge or a maximum of seven days in the ICU. Cox proportional hazards models with time-dependent covariates were used for 28- and 90-day mortality, and C-statistics to evaluate relative contribution of GIDS added to SOFA total and SOFA subscores. Binary and ordinal logistic regression were used for parenteral nutrition (PN) and ICU dependency, respectively. In total, 2679 patients from 28 sites were included. The GIDS was associated with 28- and 90-day mortality when adjusted for total SOFA score or all SOFA subscores in the full cohort analysis ( n = 2629). In the small cohort where all the variables of the GIDS were available (both intra-abdominal pressure and gastric residual volumes measured, n = 311), it associated with 28-day, but not with 90-day mortality. Adding GIDS to SOFA score slightly improved the predictive value of the latter for 28- and 90-day mortality in the full cohort analysis (C-statistic from 0.826 to 0.835 and 0.765 to 0.773, respectively). Increasing GIDS was associated with greater PN use and fewer ICU-free days. The GIDS was successfully validated against mortality and is proposed for assessment of GI dysfunction as a part of multiple organ dysfunction. The study was registered on ClinicalTrials.gov (NCT05909722) on 18.06.2023.