EA for S-AGI

Stimulated by Yu et al 2025.[1]

EA – electroacupuncture
S-AGI – sepsis-induced acute gastrointestinal injury
ICU – intensive care unit
IF – impact factor
PSM – propensity score matching
HR – hazard ratio
APACHE – acute physiology and chronic health evaluation
APACHE-II – a score applied to patients on admission to ICU for risk stratification
TCM – traditional Chinese medicine

– key to acronyms

This is a retrospective cohort study, but unlike most of those I have highlighted on the blog over recent years. This one is relatively small (n=150) and comes from a 19-bed ICU in Guangzhou, China.

The paper is published in the journal Health Science Reports (IF 2.1), which is an open access journal with a wide scope from the Wiley Online Library of over 2000 journals.

Over a period of 3.5 years, 255 S-AGI patients were identified, 50 of whom had received EA as part of their treatment. The EA treatment used in the unit was applied twice a day for 30 minutes for 7 days in patients with S-AGI. ST36 and CV4 points were used, so I assume that two pairs of leads were attached to CV4 and the other lead of each pair to ST36. We are not told the frequency, but a ‘continuous wave’ was used, which refers to a single frequency, and the intensity was set to the maximum tolerated by the patient.

Given the experimental data in animal models of sepsis, I might just use pairs at ST36 and Zongping, and avoid strong EA to the abdominal wall, which has been associated with increased lethality when applied after the onset of sepsis.[2]

2:1 PSM was used to arrive at a control cohort of 100 patients who did not receive EA.

The primary outcome was 28-day mortality.

After PSM the cohorts were well matched apart from in the highest category of AGI (IV of I–IV), which was more common in the EA cohort (16% vs 5%).

28-day mortality in the EA group was less than in the control (HR 0.52, p=0.05). Out of 50 patients in the EA group, 39 survived (78%), and out of 100 patients in the control group 62% survived.

A variety of adjustments were made based on relevant variables, such as demographics, AGI classification, ICU stay, continuous renal replacement therapy, APACHE-II scores, ventilation, lactate, and various other blood values and comorbidities. All the models used to adjust the results lowered the HR and p values slightly, which strengthens the association.

Subgroup analysis revealed slightly better effects of EA associated with more severe AGI (categories III and IV) and ventilation status.

Checking the references of this paper, I came across a paper on S-AGI and acupuncture from 2019, which I had previously missed.[3] It talked about a TCM bundle of care that included herbal medicine as well as acupuncture, but acupuncture was not mentioned in the title or abstract of the paper, so it may not have appeared on my searches. It was a prospective trial based at 5 ICUs in Hangzhou and recruited 302 patients with S-AGI between 2012 and 2014.

Patients were randomised to conventional care for sepsis and S-AGI or conventional care plus the TCM bundle. In the group receiving the TCM bundle, Chinese herbal medicine was given based on 1 of 4 TCM syndromes, but the acupuncture (EA) was applied in the same way to all patients – twice a day for 15 minutes for a total of 14 days. EA was applied at 4Hz to abdominal points (CV12, ST25) and points in tibialis anterior (ST36, ST37, ST39). Again, it is not clear exactly how the points were connected.

28-mortality was 24.5% in the conventional care group and 13.9% in the group that received the additional TCM bundle. TCM practitioners will no doubt be interested in the different outcomes based on TCM syndromes, and I will present these at the webinar tonight; however, of particular interest is the fact that Spleen-Stomach deficiency was associated with the highest 28-day mortality in the conventional care group (31.3%) and the lowest in the group receiving additional Chinese herbs and EA (7.3%).

References

1          Yu Y, Zheng B, Xu J, et al. Electroacupuncture Improves Sepsis-Induced Acute Gastrointestinal Injury: A Retrospective Propensity Score-Matched Cohort Study. Health Sci Rep. 2025;8:e70994. doi: 10.1002/hsr2.70994

2          Liu S, Wang Z-F, Su Y-S, et al. Somatotopic Organization and Intensity Dependence in Driving Distinct NPY-Expressing Sympathetic Pathways by Electroacupuncture. Neuron. 2020;108:436-450.e7. doi: 10.1016/j.neuron.2020.07.015

3          Xing X, Zhi Y, Lu J, et al. Traditional Chinese medicine bundle therapy for septic acute gastrointestinal injury: A multicenter randomized controlled trial. Complement Ther Med. 2019;47:102194. doi: 10.1016/j.ctim.2019.102194

Declaration of interests MC