Objective To construct a scientific，systematic，and clinically applicable predictive indicator system for feeding intolerance in critically ill patients，providing a basis for early identification of high-risk patients and the development of predictive models. Methods Evidence on existing predictive factors was integrated through a systematic review，and indicators were screened via two rounds of Delphi expert consultation. A meta-analysis of 27 studies was conducted，and 17 experts in critical care medicine，nursing，and nutrition were invited to rate the importance of indicators using the Likert 5-point scale. Indicators were selected based on mean score，coefficient of variation，and full-score rate. Results A predictive indicator system comprising 6 first-level indicators and 29 second-level indicators was established，covering individual characteristics，disease severity，biochemical indicators，treatment factors，nutritional support strategies，and gastrointestinal function factors. The expert authority coefficients were 0.920 and 0.923，and the coordination coefficients were statistically significant（P<0.05）. Key indicators，including APACHE Ⅱ score，SOFA score，mechanical ventilation，intra-abdominal pressure，and antral motility index，achieved high consensus. Conclusion This study systematically integrated evidence-based findings and expert consensus to develop a clinically applicable predictive indicator system for feeding intolerance in critically ill patients，providing a scientific foundation for precise nutritional management. Future research should focus on model development and clinical validation to translate the system into practical tools.
