Clinical utility of the gastrointestinal dysfunction score versus acute gastrointestinal injury grade for short-term risk stratification in critically ill patients: evidence from two prospective cohorts

Objectives To compare whether GIDS or AGI grade is more strongly associated with short-term outcomes in critically ill patients. Methods We conducted a secondary analysis of two prospectively collected cohorts. The primary analyses was conducted using the single-center FJLU cohort of critically ill adults with organ failure (SOFA ≥2 within 24 h of ICU admission), and externally validated using the multicentre NEED trial cohort. The primary outcomes were 28-day mortality and ICU-free days to day 28. Associations with mortality were assessed using Cox models, discrimination by ROC curves with the DeLong test, and trends in ICU-free days using the Jonckheere–Terpstra test. Results A total of 1,995 patients were included (FJLU n = 1,091; NEED n = 904), with 28-day mortality of 20.2 and 13.4%, respectively. Both AGI grade and GIDS were independently associated with higher 28-day mortality [FJLU: HR 1.45 (1.24–1.70) for AGI; 1.49 (1.27–1.75) for GIDS, per point increase]. Overall discrimination was similar, but GIDS performed better in more severely ill patients (APACHE II ≥ 15 or SOFA ≥8). GIDS also showed a more consistent inverse association with ICU-free days. Findings were validated in the NEED cohort. Conclusion Both GIDS and AGI were associated with short-term outcomes in critically ill patients, with comparable overall prognostic performance. GIDS may provide additional value in patients with greater illness severity. Clinical trial registration Identifier ChiCTR2300071370; ISRCTN12233792.