الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Intensive care has developed over the past 30 years with little rigorous scientific evidence about what is, or is not, clinically effective. Without these data, doctors delivering intensive care often have to decide which patients can benefit most. Scoring systems have been developed in response to an increasing emphasis on the evaluation and monitoring of health services. These systems enable comparative audit and evaluative research of intensive care.
Different gastrointestinal complications (decreased bowel sounds, delayed gastric emptying, and diarrhoea) may occur in up to 50% of mechanically ventilated patients . Intolerance to gastric feeding due to delayed gastric emptying occurs in approximately half of critically ill patients and has an adverse impact on intensive care unit (ICU) mortality and length of stay .
The impact of gastrointestinal failure syndrome (GIF) on ICU mortality and length of stay clearly points out the need for predictors for GIF using patient characteristics on the day of admission. Identifying the population at risk would clearly be beneficial, allowing the practitioner to apply necessary strategies to prevent the development of the syndrome .
None of the scoring systems for organ dysfunction and severity of illness widely used today take the function of the gastrointestinal tract into account. The multiple organ failure (MOF) score, one of the first attempts to quantify the severity of organ dysfunction and failure, originally included gastrointestinal tract when it was developed in 1985 . Revision of the score 15 years later however, concluded that GIF should not be considered in the assessment of the MOF score due to problems in definition and reliability .
More than 10 years ago the summary of a roundtable conference in gut dysfunction in critical illness concluded that intestinal function is an important determinant of outcome in critically ill patients, that there is no objective, clinically relevant definition of intestinal dysfunction in critical illness and any definition developed in the future should grade the severity of the dysfunction. A scoring system for gastrointestinal dysfunction is thus warranted, and the continuing lack of a systematic approach is limiting studies conducted to assess epidemiology, time course, risk factors and treatment .
Reintam and colleagues recently proposed for the first time a Score of gastrointestinal failure (GIF), and confirmed its Association with poor outcome.They combined gastrointestinal symptoms and IAH into a 5-grade scale - the Gastrointestinal Failure (GIF) score.
The present study included 100 adult critically ill patients of both sex admitted consecutively to the units of critical care department and stayed more than 7 days. We correlated the demographic data of the patients, level of consciousness of the patients by using Glasgow Coma Score (GCS), severity of illness by using Sequential Organ Failure Assessment score (SOFA) with Gastro Intestinal failure (GIF) score and with the outcome of the patients according to Glasgow outcome score, Intensive care unit stay and in hospital mortality. The aim of this prospective study is to evaluate the predictive value of implications of gastrointestinal failure score (GIF) in critically ill patients.
The study showed no significant statistical relation between the age of the patients and the different GIF score.
The present study showed that the number of males (60 patients) was higher than females (40 patients) with no significant relation between the sex of the patients and the GIF score.
Glasgow coma score of the studied patients was ranged between 3 -15 with a mean (12.95± 3.292). It was found that no statistical significant relation between severity of Glasgow coma score and GIF score in the studied patients.
In the study, SOFA score was ranged between 0 -18 with a mean score (6.83± 3.856). It was found that there is significant Statistical direct relation between severity of SOFA score and GIF score as with increasing severity of SOFA score there was significant increase in the severity of GIF score.
performance of the GIF score was studied by comparing it with the SOFA score .Aspects of comparison were sensitivity, specificity for I.C.U mortality. The study showed that area under the GIF curve was (0.694), i.e. there was a significant value for prediction of mortality of the patients, and it was found that the area under the SOFA curve was (0.792), i.e. there was a significant value for prediction of outcome of the patients, SOFA score had the highest sensitivity, specificity while the GIF score is less sensitive and specific but still considered GIF score as a good indicator to outcome of the patients.
In the study, total mortality was 10 cases (10٪) there is direct correlation between the number as well as the percentage of mortality per each GIF score in the studied patients.
In the study there was a statistical significance relationship between the severity of GIF score and duration of stay in ICU as with increasing GIF score the duration of stay increased
Patients were classified according to Glasgow Outcome Scale (GOS) into 2 groups, the first had good prognosis that include patients who were fully recovered or had moderate disability. The second group had poor prognosis that include patients who were died, vegetative, or had severe disability. It was found that there is statistical correlation between them as with increasing the severity of GIF score there is a significant increase in the severity of Glasgow outcome scale.