Gastrointestinal complications are associated with a poor outcome in non-critically ill pneumonia patients

Chun-Ta Huang,Chun-Ming Hong,Yi-Ju Tsai,Chong-Jen Yu,Wang-Huei Sheng

doi:10.1186/s12876-020-01537-z

Abstract

BackgroundDevelopment of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. However, little is known about their impact on the outcome of non-critically ill patients. In this study, we aimed to investigate the incidence of GI complications and their influence on prognosis of hospitalized pneumonia patients.MethodsAdult patients admitted with a diagnosis of pneumonia from 2012 to 2014 were included. Medical records were reviewed to obtain patients’ demographics, physical signs, comorbidities, laboratory results, clinical events, and the Confusion, Urea, Respiratory rate, Blood pressure and age ≥ 65 (CURB-65) score was calculated to assess the severity of pneumonia. GI complications, including bowel distension, diarrhea, GI bleeding and ileus, were evaluated during the first 3 days of hospitalization and their association with patient outcomes, such as hospital mortality and length of stay, was analyzed.ResultsA total of 1001 patients were enrolled, with a mean age of 73.7 years and 598 (59%) male. Among them, 114 (11%) patients experienced at least one GI complication and diarrhea (5.2%) was the most common. The hospital mortality was 14% and was independently associated with an increase in the CURB-65 score (odds ratio [OR] 1.952 per point increase; 95% confidence interval [CI] 1.516–2.514), comorbid malignancy (OR 1.943; 95% CI 1.209–3.123), development of septic shock (OR 25.896; 95% CI 8.970–74.765), and the presence of any GI complication (OR 1.753; 95% CI 1.003–3.065).ConclusionsCompared to a critical care setting, GI complications are not commonly observed in a non-critical care setting; however, they still have a negative impact on prognosis of pneumonia patients, including higher mortality and prolonged length of hospital stay.

Highlights

Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill
The present study shows that, in a non-critical care setting, 1 out of 9 pneumonia patients would experience GI complications during the first 3 days of admission and these complications were associated with a higher odds of hospital mortality and a longer length of hospital stay
The findings indicate a deleterious role of GI complications in patients hospitalized for pneumonia and suggest that the importance of the GI tract in the pathophysiology of non-GI diseases should not be overlooked

Summary

Introduction

Development of gastrointestinal (GI) complications is adversely associated with prognosis in the critically ill. Huang et al BMC Gastroenterol (2020) 20:383 may not be viewed as an innocent victim but can otherwise precipitate deleterious consequences Along this line, GI dysfunction has been proposed to be the motor of multiple organ dysfunction in critical illness the pathophysiology involved (e.g., bacterial translocation, altered intestinal tight junctions, cytokine production and interaction with the gut microbiome) remains incompletely understood [3, 7,8,9]. We chose to focus on the analysis of clinical information on patients with pneumonia because it is the most common cause of hospitalization and carries a significant risk of mortality around the globe By this way, we could include a more homogeneous patient population for comparisons of clinical presentation and disease severity between different groups of study subjects

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